Barotrauma during non-invasive ventilation for acute respiratory distress syndrome caused by COVID-19: a balance between risks and benefits

2021 ◽  
Vol 82 (6) ◽  
pp. 1-9
Author(s):  
M Gabrielli ◽  
F Valletta ◽  
F Franceschi ◽  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Positive Pressure ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

Ventilatory support is vital for the management of severe forms of COVID-19. Non-invasive ventilation is often used in patients who do not meet criteria for intubation or when invasive ventilation is not available, especially in a pandemic when resources are limited. Despite non-invasive ventilation providing effective respiratory support for some forms of acute respiratory failure, data about its effectiveness in patients with viral-related pneumonia are inconclusive. Acute respiratory distress syndrome caused by severe acute respiratory syndrome-coronavirus 2 infection causes life-threatening respiratory failure, weakening the lung parenchyma and increasing the risk of barotrauma. Pulmonary barotrauma results from positive pressure ventilation leading to elevated transalveolar pressure, and in turn to alveolar rupture and leakage of air into the extra-alveolar tissue. This article reviews the literature regarding the use of non-invasive ventilation in patients with acute respiratory failure associated with COVID-19 and other epidemic or pandemic viral infections and the related risk of barotrauma.

scholarly journals Non-Invasive Ventilation: a Safe and Effective Respiratory Support Method in Hypoxemic Acute Respiratory Failure Due to Pneumonia with or without Acute Respiratory Distress Syndrome

Folia Medica ◽  
2021 ◽  
Vol 63 (3) ◽  
pp. 321-328
Author(s):  
Viktoria Ilieva ◽  
Yordanka Yamakova
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Respiratory Distress Syndrome ◽  
Distress Syndrome ◽  
Respiratory Support ◽  
Invasive Ventilation ◽  
Safety And Efficacy ◽  
Non Invasive ◽  
Non Invasive Ventilation

Introduction: The benefit of non-invasive ventilation (NIV) in cases of hypercapnic acute respiratory failure (ARF) has already been proven. Still, its safety and efficacy as a respiratory support method for patients with hypoxemic ARF hasn’t been studied so well.Aim: The aim of our study was to examine the safety and efficacy of NIV in hypoxemic ARF of primary lung origin.Materials and methods: This was a prospective observational cohort study of patients with hypoxemic ARF due to communityacquired pneumonia with or without acute respiratory distress syndrome (ARDS) treated using NIV. They were divided into four groups: pneumonia without ARDS, mild, moderate, or severe ARDS. Their clinical and ABG parameters were recorded before initiation of NIV, at 1 hour and 24 hours after ventilation onset and at transition to non-intensive NIV or before endotracheal intubation in NIV failure cases.Results: A total of 63 patients were included. NIV trial was successful in 85.71% of them, while 14.29% experienced NIV failure. In the general population, we observed a significant difference in PaO2/FiO2 only before transition to non-intensive NIV in comparison to the value at admission. This trend was seen in the patients with pneumonia without ARDS and moderate ARDS, but not in those with mild and severe ARDS. The clinical parameters showed improvement early in the course of treatment both in the entire study population and all subgroups.Conclusions: NIV is an effective and safe option for respiratory support in patients with severe CAP only when an adequate etiological treatment has been applied.

scholarly journals Comparison of the clinical outcomes of non-invasive ventilation by helmet vs facemask in patients with acute respiratory distress syndrome

Medicine ◽  
2021 ◽  
Vol 100 (4) ◽  
pp. e24443
Author(s):  
Mohamad Y. Khatib ◽  
Mohamed Z. Peediyakkal ◽  
Moustafa S. Elshafei ◽  
Hani S. Elzeer ◽  
Dore C. Ananthegowda ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Clinical Outcomes ◽  
Distress Syndrome ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

scholarly journals Positive end expiratory pressure in invasive and non-invasive ventilation of COVID-19 acute respiratory distress syndrome: computational modeling illuminates the data

2021 ◽  
Author(s):  
Liam Weaver ◽  
Declan G. Bates ◽  
Luigi Camporota
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Computational Models ◽  
Distress Syndrome ◽  
Lung Protective Ventilation ◽  
Invasive Ventilation ◽  
Positive End Expiratory Pressure ◽  
Non Invasive ◽  
Non Invasive Ventilation

Positive end expiratory pressure (PEEP) is routinely used as part of lung protective ventilation strategies in the treatment of acute respiratory distress syndrome (ARDS). In the case of ARDS arising due to COVID-19 (CARDS), there is some debate as to whether the atypical pathophysiological characteristics of the disease which lead to hypoxaemia could warrant a modified approach to ventilator management, particularly with regards to PEEP settings. Here we review the available evidence for the existence of a unique underlying lung pathophysiology in CARDS, and for the suitability of standard approaches to setting PEEP, in both the invasive and non-invasive ventilation settings. We show how detailed computational models informed by this evidence can shed light on the available data, and help to interpret recent results in the literature.

Does proning on NIV improve oxygenation?

2020 ◽  
Vol 13 (10) ◽  
pp. e235243
Author(s):  
Syed Muhammad Tahir Nasser ◽  
Madan Narayanan
Keyword(s):  
Intensive Care Unit ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Potential Risks

Proning intubated patients with acute respiratory distress syndrome (ARDS) is an established practice to improve oxygenation temporarily. We present two cases of patients on our intensive care unit with ARDS, on non-invasive ventilation (NIV), in whom proning improved oxygenation at a stage when intubation was the next step. We discuss the mechanisms by which proning improves oxygenation as well as the potential risks proning on NIV brings, for which we make specific recommendations.

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