scholarly journals Awake Proning as an Adjunctive Therapy for Refractory Hypoxemia in Non-Intubated Patients with COVID-19 Acute Respiratory Failure: Guidance from an International Group of Healthcare Workers

2021 ◽  
Author(s):  
Willemke Stilma ◽  
Eva Åkerman ◽  
Antonio Artigas ◽  
Andrew Bentley ◽  
Lieuwe D. Bos ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Work Of Breathing ◽  
Supplemental Oxygen ◽  
Expert Advice ◽  
Adjunctive Treatment ◽  
Middle Income ◽  
Resource Limited ◽  
Refractory Hypoxemia ◽  
Potential Benefits

Non-intubated patients with acute respiratory failure due to COVID-19 could benefit from awake proning. Awake proning is an attractive intervention in settings with limited resources, as it comes with no additional costs. However, awake proning remains poorly used probably because of unfamiliarity and uncertainties regarding potential benefits and practical application. To summarize evidence for benefit and to develop a set of pragmatic recommendations for awake proning in patients with COVID-19 pneumonia, focusing on settings where resources are limited, international healthcare professionals from high and low- and middle-income countries (LMICs) with known expertise in awake proning were invited to contribute expert advice. A growing number of observational studies describe the effects of awake proning in patients with COVID-19 pneumonia in whom hypoxemia is refractory to simple measures of supplementary oxygen. Awake proning improves oxygenation in most patients, usually within minutes, and reduces dyspnea and work of breathing. The effects are maintained for up to 1 hour after turning back to supine, and mostly disappear after 6–12 hours. In available studies, awake proning was not associated with a reduction in the rate of intubation for invasive ventilation. Awake proning comes with little complications if properly implemented and monitored. Pragmatic recommendations including indications and contraindications were formulated and adjusted for resource-limited settings. Awake proning, an adjunctive treatment for hypoxemia refractory to supplemental oxygen, seems safe in non-intubated patients with COVID-19 acute respiratory failure. We provide pragmatic recommendations including indications and contraindications for the use of awake proning in LMICs.

EFFECT OF ALBUTEROL ON WORK OF BREATHING IN ACUTE RESPIRATORY FAILURE

1988 ◽  
Vol 16 (4) ◽  
pp. 454
Author(s):  
Denny P. Laporta ◽  
Allen H. Spanier ◽  
Tetsuo Kochi ◽  
Joseph Milic Emili
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Work Of Breathing

scholarly journals Timing and causes of death in severe COVID-19 patients

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Charles de Roquetaillade ◽  
Swann Bredin ◽  
Jean-Baptiste Lascarrou ◽  
Thibaud Soumagne ◽  
Mariana Cojocaru ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Median Time ◽  
Causes Of Death ◽  
Secondary Infection ◽  
Multiple Organ ◽  
Multicenter Observational Study ◽  
Icu Admission ◽  
Secondary Infections ◽  
Refractory Hypoxemia

Abstract Background Previous studies reporting the causes of death in patients with severe COVID-19 have provided conflicting results. The objective of this study was to describe the causes and timing of death in patients with severe COVID-19 admitted to the intensive care unit (ICU). Methods We performed a retrospective study in eight ICUs across seven French hospitals. All consecutive adult patients (aged ≥ 18 years) admitted to the ICU with PCR-confirmed SARS-CoV-2 infection and acute respiratory failure were included in the analysis. The causes and timing of ICU deaths were reported based on medical records. Results From March 1, 2020, to April 28, 287 patients were admitted to the ICU for SARS-CoV-2 related acute respiratory failure. Among them, 93 patients died in the ICU (32%). COVID-19-related multiple organ dysfunction syndrome (MODS) was the leading cause of death (37%). Secondary infection-related MODS accounted for 26% of ICU deaths, with a majority of ventilator-associated pneumonia. Refractory hypoxemia/pulmonary fibrosis was responsible for death in 19% of the cases. Fatal ischemic events (venous or arterial) occurred in 13% of the cases. The median time from ICU admission to death was 15 days (25th–75th IQR, 7–27 days). COVID-19-related MODS had a median time from ICU admission to death of 14 days (25th–75th IQR: 7–19 days), while only one death had occurred during the first 3 days since ICU admission. Conclusions In our multicenter observational study, COVID-19-related MODS and secondary infections were the two leading causes of death, among severe COVID-19 patients admitted to the ICU.

Effects of High-Flow Nasal Cannula on the Work of Breathing in Patients Recovering From Acute Respiratory Failure*

2017 ◽  
Vol 45 (12) ◽  
pp. 1981-1988 ◽  
Author(s):  
Mathieu Delorme ◽  
Pierre-Alexandre Bouchard ◽  
Mathieu Simon ◽  
Serge Simard ◽  
François Lellouche
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Work Of Breathing ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula

scholarly journals A Narrative Summary of High Flow Nasal Cannula Therapy in the Adult Population

2017 ◽  
Author(s):  
Joshua Gonzales ◽  
Kevin Collins ◽  
Christopher Russian
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Oxygen Therapy ◽  
Work Of Breathing ◽  
High Flow ◽  
Nasal Cannula ◽  
Positive Pressure ◽  
High Flow Nasal Cannula ◽  
Non Invasive ◽  
Clinical Benefits

Purpose: The aim of this narrative review is to outline the mechanism of action of HFNC therapy, the clinical benefits of its use, cautions of its clinical application and limitations of previous research. Methods: A literature review was conducted using the following databases as sources: Medline, PubMed, and Google Scholar. Only publications written in English were used in this clinical review. Keywords used in the search included the following: high-flow nasal cannula, heated humidified oxygen, oxygen therapy, non-invasive ventilation, and respiratory failure. Results: The literature reveals HFNC therapy significantly decreased the use of mechanical ventilation (invasive or non-invasive) in patients experiencing respiratory failure. HFNC therapy was better tolerated by patients and decreased the patient’s work of breathing when compared to a conventional oxygen therapy (i.e., non-rebreather oxygen mask). Other clinical benefits of using HFNC when changing a patient from conventional facemask oxygen therapy to a HFNC device are significant improvements in PaO2, respiratory rate and overall comfort. Conclusions: High flow nasal cannula (HFNC) therapy serves as an alternative to conventional oxygen therapy to deliver elevated concentrations of oxygen to patients experiencing acute respiratory failure. Information detailed in this article suggests HFNC therapy is an effective therapy for improving a patient’s oxygenation status when experiencing acute respiratory failure in adults. The literature reveals, it is reasonable to initiate HFNC in adults with acute hypoxemic respiratory failure without hypercapnia, as an alternative to standard oxygen therapy or noninvasive positive pressure ventilation.

Nasal Cannula, CPAP, and High-Flow Nasal Cannula: Effect of Flow on Temperature, Humidity, Pressure, and Resistance

2011 ◽  
Vol 45 (1) ◽  
pp. 69-74 ◽  
Author(s):  
Gordon Y. Chang ◽  
Cynthia A. Cox ◽  
Thomas H. Shaffer
Keyword(s):  
Positive Airway Pressure ◽  
Work Of Breathing ◽  
Supplemental Oxygen ◽  
High Flow ◽  
Nasal Cannula ◽  
In Vivo Studies ◽  
High Flow Nasal Cannula ◽  
Potential Benefits ◽  
Flow Pressure

Abstract Background: Delivery of warm, humidified, supplemental oxygen via high-flow nasal cannula has several potential benefits; however, the high-flow range may not maintain humidification and temperature and in some cases may cause excessive expiratory pressure loading. Objective: To compare the effect of flow on temperature, humidity, pressure, and resistance in nasal cannula (NC), continuous positive airway pressure (CPAP), and high-flow nasal cannula (HFNC) in a clinical setting. Methods: The three delivery systems were tested in the nursery using each instrument's recommended specifications and flow ranges (0–3 L/min and 0–8 L/min). Flow, pressure, temperature, and humidity were measured, and resistance was calculated. Results: For all devices at 0–3 L/min, there was a difference (p<0.01) in temperature (NC 35.9°C > CPAP 34.5°C > HFNC 34.0°C), humidity (HFNC 82% > CPAP 77% > NC 57%), pressure (HFNC 22 cmH2O > NC 4 cmH2O > CPAP 3 cmH2O), and resistance (HFNC 636 cmH2O/L/sec > NC 270 cmH2O/L/sec > CPAP 93 cmH2O/L/sec) as a function of flow. For HFNC and CPAP at 0–8 L/min, there was a difference (p<0.01) in temperature (CPAP 34.5°C > HFNC 34.0°C) in humidity (HFNC 83 % > CPAP 76 %), pressure (HFNC 56 cmH2O > CPAP 14 cmH2O) and resistance (HFNC 783 cmH2O/L/sec > CPAP 280 cmH2O/L/sec) as a function of flow. Conclusions: Gas delivered by HFNC was more humid than NC and CPAP. However, the higher pressure and resistance delivered by the HFNC system may have clinical relevance, such as increased work of breathing, and warrants further in vivo studies.

scholarly journals Managing Persistent Hypoxemia: what is new?

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 1993
Author(s):  
Jesús Villar ◽  
Carlos Ferrando ◽  
Robert M Kacmarek
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Life Support ◽  
Current Knowledge ◽  
Positive End Expiratory Pressure ◽  
Refractory Hypoxemia ◽  
Standard Life ◽  
Inspired Oxygen ◽  
Review Current

Mechanical ventilation is the standard life-support technique for patients with severe acute respiratory failure. However, some patients develop persistent and refractory hypoxemia because their lungs are so severely damaged that they are unable to respond to the application of high inspired oxygen concentration and high levels of positive end-expiratory pressure. In this article, we review current knowledge on managing persistent hypoxemia in patients with injured lungs.

Characteristics of Medically Transported Critically Ill Children with Respiratory Failure in Latin America: Implications for Outcomes

2021 ◽  
Author(s):  
Jesus A. Serra ◽  
Franco Díaz ◽  
Pablo Cruces ◽  
Cristobal Carvajal ◽  
Maria J. Nuñez ◽  
...  
Keyword(s):  
Latin America ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Critically Ill ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Factors Associated ◽  
Resource Limited

AbstractSeveral challenges exist for referral and transport of critically ill children in resource-limited regions such as Latin America; however, little is known about factors associated with clinical outcomes. Thus, we aimed to describe the characteristics of critically ill children in Latin America transferred to pediatric intensive care units for acute respiratory failure to identify risk factors for mortality. We analyzed data from 2,692 patients admitted to 28 centers in the Pediatric Collaborative Network of Latin America Acute Respiratory Failure Registry. Among patients referred from another facility (773, 28%), nonurban transports were independently associated with mortality (adjusted odds ratio = 9.4; 95% confidence interval: 2.4–36.3).

Sign in / Sign up

Export Citation Format

Share Document