scholarly journals Noninvasive Respiratory Support in Acute Hypoxemic Respiratory Failure

2019 ◽  
Vol 64 (6) ◽  
pp. 638-646 ◽  
Author(s):  
Thomas Piraino
Keyword(s):  
Respiratory Failure ◽  
Respiratory Support ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure

Is high-flow nasal cannula oxygenation more effective than noninvasive ventilation or conventional oxygen therapy in treating acute hypoxemic respiratory failure in COVID-19 patients?

2020 ◽  
Vol 54 ◽  
Author(s):  
Cary Amiel G. Villanueva ◽  
Marie Gene D. Cruz ◽  
Lia M. Palileo-Villanueva
Keyword(s):  
Respiratory Failure ◽  
Noninvasive Ventilation ◽  
Observational Studies ◽  
Oxygen Therapy ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
High Flow Nasal Cannula ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure

KEY FINDINGSVery low-quality evidence suggests lower mortality (based on five observational studies) but higher failurerate of respiratory support (based on two observational studies) in COVID-19 patients given high-flow nasalcannula (HFNC) oxygen compared with noninvasive ventilation (NIV) and conventional oxygenation therapy.Randomized controlled trials (RCT) are urgently needed in this area.• Respiratory failure accounts for about half of deaths in patients with COVID-19.• High-flow nasal cannula (HFNC) oxygen therapy reduces the need for escalating respiratory support and improvespatient comfort compared with conventional oxygen therapy among those with acute respiratory failure.• Mortality was consistently lower in COVID-19 patients who received HFNC rather than NIV or conventionaloxygen therapy (COT) across 5 very low-quality retrospective observational studies from China.• Several international guidelines recommend the use of HFNC oxygen therapy in COVID-19 patients whodevelop acute hypoxemic respiratory failure. However, local guidelines from the Philippine Society forMicrobiology and Infectious Diseases (PSMID) and the Philippine College of Chest Physicians (PCCP) recommendagainst HFNC due to risks of transmission and paucity of direct evidence for efficacy.• Additional infection control precautions, i.e. wearing a surgical mask over the cannula, and locating in a negativepressure room, are recommended whenever using HFNC or NIV.• There are at least two ongoing trials due to be completed by the second quarter of 2021 comparingHFNC oxygenation with NIV or COT in COVID-19 patients.

scholarly journals Noninvasive respiratory support in acute hypoxemic respiratory failure associated with COVID-19 and other viral infections

2020 ◽  
Author(s):  
Claudia Crimi ◽  
Alberto Noto ◽  
Andrea Cortegiani ◽  
Pietro Impellizzeri ◽  
Mark Elliott ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Viral Infections ◽  
Evidence Synthesis ◽  
Controlled Trial ◽  
Viral Pneumonia ◽  
Respiratory Support ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure ◽  
Randomized Controlled ◽  
Exhaled Air

ABSTRACTIntroductionNoninvasive respiratory support (NRS) such as noninvasive ventilation (NIV) and high flow nasal therapy (HFNT) have been used in the treatment of acute hypoxemic respiratory failure (AHRF) related to the coronavirus disease (COVID-19) and other viral infections. However, there is a lack of consensus in favor of or against NRS use due to the risks of worsening hypoxemia, intubation delay, and aerosols environmental contamination associated with the use of these tools. We aimed to summarize the evidence on the use of NRS in adult patients with COVID-19 and other viral pneumonia (i.e. H1N1, SARS, MERS) and AHRF. We also searched for studies evaluating the risk of aerosolization/contamination with these tools.Evidence AcquisitionWe searched MEDLINE, PubMed EMBASE and two major preprint servers (biorXiv and medRxiv) from inception to April 14, 2020, for studies on the use of respiratory support in AHRF and viral pneumonia.Evidence SynthesisThe search identified 4086 records and we found only one randomized controlled trial out of 58 studies included, with great variabilities in support utilization and failure rates. Fifteen studies explored the issue of aerosolization/contamination showing a high risk of airborne transmission via droplets generation during the use of these modalitiesConclusionsUse of NRS and treatment failure in the context of COVID-19 and viral infection associated-AHRF, varied widely. Dispersion of exhaled air is different depending on the type of respiratory therapies and interfaces. Data from randomized controlled trials are lacking.

scholarly journals Prolonged non-invasive respiratory support in a COVID-19 patient with severe acute hypoxemic respiratory failure

2021 ◽  
Author(s):  
Andrea Lanza ◽  
Maurizio Sommariva ◽  
Sara Mariani ◽  
Gabriela Ferreyra ◽  
Giuliana Enrica Stagni ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Ventilatory Support ◽  
Respiratory Support ◽  
Low Flow ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure ◽  
Non Invasive ◽  
High Dependency ◽  
Non Invasive Ventilation ◽  
Experienced Team

A pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 was declared in 2020. Severe cases were characterized by the development of acute hypoxemic respiratory failure (AHRF) requiring advanced respiratory support. However, intensive care units (ICU) were saturated, and many patients had to be treated out of ICU. This case describes a 75-year-old man affected by AHRF due to Coronavirus Disease 2019 (COVID-19), hospitalized in a high-dependency unit, with PaO2/FiO2 <100 for 28 consecutive days. An experienced team with respiratory physiotherapists was in charge of the noninvasive ventilatory support (NIVS). The patient required permanent NIVS with continuous positive airway pressure, non-invasive ventilation, high flow nasal oxygen and body positioning. He was weaned from NIVS after 37 days and started exercise training afterwards. The patient was discharged at home with low-flow oxygen therapy. This case represents an example of a successful treatment of AHRF with the still controversial noninvasive respiratory support in one patient with COVID-19.

scholarly journals Use of non-invasive ventilation in acute respiratory failure due to SARS-CoV-2 pneumonia: typing of patients and choice of respiratory support, the role of internal medicine

2020 ◽  
Author(s):  
Federico Lari ◽  
Fabrizio Giostra ◽  
Stefania Guerrini
Keyword(s):  
Respiratory Failure ◽  
De Novo ◽  
Respiratory Support ◽  
Invasive Ventilation ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Severe Acute Respiratory Infection ◽  
Prognostic Stratification

The use of non-invasive ventilation (NIV) during de novo acute hypoxemic respiratory failure is not recommended by the guidelines because NIV does not improve the prognosis. With the advent of the new coronavirus, many cases of acute hypoxemic respiratory failure associated with the infection (severe acute respiratory infection) have been observed: data are missing regarding the use of NIV in this particular clinical condition, but a correct typing of patients based on different clinical, pathophysiological and radiological characteristics, could help in prognostic stratification and in the choice of respiratory support (invasive versus non-invasive). During NIV in these patients particular attention is paid to the possibility of environmental dissemination of the virus and consequently adequate technical precautions are taken.

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