Beyond the guidelines for non-invasive ventilation in acute respiratory failure: implications for practice

Bourke, SC; Piraino, Thomas; Pisani, Lara; Brochard, Laurent; Elliott, Mark

doi:10.1016/s2213-2600(18)30388-6

Cited by 44 publications

(39 citation statements)

References 99 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This group are not included in the RCTs and have a higher mortality than those presenting with AHRF (24.6% vs 18%, p=0.001) particularly when given NIV later than 24 hours into the admission. This second group of patients who develop acidosis after admission are not well studied and do not have a solid evidence base on which to inform NIV management2 4 18 . What the audit data tell us is that they have similar patient characteristics to those admitted with acidotic hypercapnic respiratory failure except their admission blood gases show a pH within the normal range and their PaCO 2 levels are not raised to the same degree as the admission acidotic patients.…”

Section: Discussionmentioning

confidence: 99%

Time to NIV and mortality in AECOPD hospital admissions: an observational study into real world insights from National COPD Audits

et al. 2019

View full text Add to dashboard Cite

BackgroundRandomised control trial (RCT)-derived survival figures for acute exacerbation of chronic obstructive pulmonary disease admissions managed with non-invasive ventilation (NIV) have not been replicated in UK clinical audits. Subsequent guidelines have emphasised the need for timely NIV application.MethodsData from the 2008 and 2014 national chronic obstructive pulmonary disease audits was used to analyse the association between time to NIV and mortalityResults1032 patients received NIV in 2008, and 1612 in 2014. Overall mortality rates reduced between the audits from 24.9% in 2008 to 16.8% in 2014 but time to NIV lengthened. In 2014, 20.9% of patients received NIV within 60 min versus 24.9% in 2008 (p=0.001). The proportion of patients receiving NIV between 3 and 24 hours increased from 31.3% in 2008 to 39% in 2014 (p=0.001). Patients admitted with hypercapnic acidotic respiratory failure who received NIV within 3 hours had lower in-patient mortality than those who received NIV between 3 and 24 hours, 15.9% versus 18.4%, but this did not reach statistical significance (p=0.425), but acidotic patients receiving NIV >24 hours after admission had significantly higher mortality (28.9%, p=0.002). A second cohort admitted with hypercapnia but normal range pH, who developed later acidosis, had higher mortality (24.6%), compared with those acidotic on admission (18% p≤0.001) and an extremely high mortality when NIV was given >24 hours after admission (42.6%).ConclusionSurvival rates for those treated with NIV has improved between the two audits but remains lower than reported in RCTs. Patients who developed acidosis after admission and received NIV later in the hospital stay have even higher mortality and deserve further study and clinical attention.

show abstract

Section: Discussionmentioning

confidence: 99%

Time to NIV and mortality in AECOPD hospital admissions: an observational study into real world insights from National COPD Audits

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Monitoring includes verifying oxygen saturation, blood gas levels, and tidal volumes, but also assessing the patient's clinical condition. Deteriorating oxygen supply with a PaO 2 /FiO 2 < 150 or 175 mm Hg after 1 h of NIV, a respiratory rate of > 30/min, a high APACHE score, and a HACOR score > 5 are associated with a significantly worse prognosis [120][121][122][123]. This results in the suggested therapy algorithm shown in Figure 2.…”

Section: Indication Algorithmmentioning

confidence: 99%

“…A deterioration in oxygen saturation with a PaO 2 /FiO 2 < 150 or 175 mm Hg after 1 h of NIV, a respiratory rate > 30/min, a high APACHE score, and a HACOR score > 5 are indications for endotracheal intubation in patients with a curative treatment goal [120][121][122][123].…”

Section: Evaluation Of Clinical Development and Management In Icumentioning

confidence: 99%

Position Paper for the State-of-the-Art Application of Respiratory Support in Patients with COVID-19

et al. 2020

View full text Add to dashboard Cite

Against the background of the pandemic caused by infection with the SARS-CoV-2 virus, the German Respiratory Society has appointed experts to develop therapy strategies for CO-VID-19 patients with acute respiratory failure (ARF). Here we present key position statements including observations about the pathophysiology of (ARF). In terms of the pathophysiology of pulmonary infection with SARS-CoV-2, COV-ID-19 can be divided into 3 phases. Pulmonary damage in advanced COVID-19 often differs from the known changes in acute respiratory distress syndrome (ARDS). Two types (type L and type H) are differentiated, corresponding to early-and late-stage lung damage. This differentiation should be taken into consideration in the respiratory support of ARF. The assessment of the extent of ARF should be based on arterial or This is the translation of a German article "Positionspapier zur praktischen Umsetzung der apparativen Differenzialtherapie der akuten respiratorischen Insuffizienz bei COVID-19" by Pfeifer et al. [Pneumologie. Stuttgart: Thieme; 2020]. Translated by: Dipl. Dol. G. M. Mundt.

show abstract

“…If the patient is agitated it must first be ensured that the agitation is not due to inappropriately applied NIV or a poorly fitting mask etc and then low dose sedation can be considered though only in an environment where close monitoring is possible. 14…”

Section: Contraindicationsmentioning

confidence: 99%

Acute non-invasive ventilation – getting it right on the acute medical take

Ghosh

Elliott

2019

Clinical Medicine

Self Cite

View full text Add to dashboard Cite

Non-invasive ventilation (NIV) given to the right patient, in the right setting, in the right way and at the right time improves outcomes. However, national audits reveal poor practice in patient selection, clinical judgement, treatment initiation and availability of trained staff. NIV is indicated for persistent acute hypercapnic respiratory failure (AHRF) with acidosis after usual medical management in chronic obstructive pulmonary disease (COPD) exacerbation and even without acidosis in neuromuscular disorders or other restrictive conditions eg obesity hypoventilation or kyphoscoliosis. Having trained staff in a suitable environment with adequate equipment are keys to its success, along with close monitoring. A plan should be put in place at the time of initiating NIV about the ceiling of care, eg escalation to intubation or palliation, if the patient is not improving with NIV. Early NIV failure is most likely due to technical issues, such as inadequate pressures or mask leak, while late failure is usually the consequence of advanced disease. Any presentation with AHRF is a poor prognostic indicator and outpatient respiratory follow-up is indicated following discharge. For selected patients with COPD who remain hypercapnic 2 weeks after an exacerbation, domiciliary NIV can reduce admissions and improve survival. For patients with neuromuscular disorders or kyphoscoliosis a presentation with AHRF almost always indicates the need for domiciliary NIV.

show abstract

Beyond the guidelines for non-invasive ventilation in acute respiratory failure: implications for practice

Cited by 44 publications

References 99 publications

Time to NIV and mortality in AECOPD hospital admissions: an observational study into real world insights from National COPD Audits

Time to NIV and mortality in AECOPD hospital admissions: an observational study into real world insights from National COPD Audits

Position Paper for the State-of-the-Art Application of Respiratory Support in Patients with COVID-19

Acute non-invasive ventilation – getting it right on the acute medical take

Contact Info

Product

Resources

About