Focus on noninvasive respiratory support before and after mechanical ventilation in patients with acute respiratory failure

Jong, Audrey De; Casey, Jonathan D; Myatra, Sheila Nainan

doi:10.1007/s00134-020-06100-8

Cited by 17 publications

(10 citation statements)

References 20 publications

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“…Incidence is even higher (25-40%) in certain patient populations (e.g., patients with heart failure or chronic obstructive pulmonary disease) [7,11]. To mitigate the risk of extubation failure, clinicians have used noninvasive respiratory support interventions in the post-extubation period to optimize gas exchange and decrease patients' oxygen cost of breathing [12]. These interventions [noninvasive positive pressure ventilation (NIPPV) and high-flow nasal cannula (HFNC)] have been shown to be efficacious in preventing initial intubation in patients with hypoxemic respiratory failure [13], but their efficacy in preventing post-extubation respiratory failure and reintubation is less clear.…”

Section: Introductionmentioning

confidence: 99%

Noninvasive respiratory support following extubation in critically ill adults: a systematic review and network meta-analysis

et al. 2021

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Purpose: Systematic review and network meta-analysis to investigate the efficacy of noninvasive respiratory strategies, including noninvasive positive pressure ventilation (NIPPV) and high-flow nasal cannula (HFNC), in reducing extubation failure among critically ill adults. Methods:We searched databases from inception through October 2021 for randomized controlled trials (RCTs) evaluating noninvasive respiratory support therapies (NIPPV, HFNC, conventional oxygen therapy, or a combination of these) following extubation in critically ill adults. Two reviewers performed screening, full text review, and extraction independently. The primary outcome of interest was reintubation. We used GRADE to rate the certainty of our findings. Results:We included 36 RCTs (6806 patients). Compared to conventional oxygen therapy, NIPPV (OR 0.65 [95% CI 0.52-0.82]) and HFNC (OR 0.63 [95% CI 0.45-0.87]) reduced reintubation (both moderate certainty). Sensitivity analyses showed that the magnitude of the effect was highest in patients with increased baseline risk of reintubation. As compared to HFNC, no difference in incidence of reintubation was seen with NIPPV (OR 1.04 [95% CI 0.78-1.38], low certainty). Compared to conventional oxygen therapy, neither NIPPV (OR 0.8 [95% CI 0.61-1.04], moderate certainty) or HFNC (OR 0.9 [95% CI 0.66-1.24], low certainty) reduced short-term mortality. Consistent findings were demonstrated across multiple subgroups, including high-and low-risk patients. These results were replicated when evaluating noninvasive strategies for prevention (prophylaxis), but not in rescue (application only after evidence of deterioration) situations. Conclusions:Our findings suggest that both NIPPV and HFNC reduced reintubation in critically ill adults, compared to conventional oxygen therapy. NIPPV did not reduce incidence of reintubation when compared to HFNC. These findings support the preventative application of noninvasive respiratory support strategies to mitigate extubation failure in critically ill adults, but not in rescue conditions.

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Section: Introductionmentioning

confidence: 99%

Noninvasive respiratory support following extubation in critically ill adults: a systematic review and network meta-analysis

et al. 2021

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“…Hence, these patients are at an increased risk of rapid desaturation during tracheal intubation. In such patients, the use of measures to prolong the safe apnea time (time until significant desaturation after inducing apnea) and optimize peri-intubation oxygenation using various strategies is paramount [20 ▪▪ ].…”

Section: Types Of Physiologically Diffcult Airwaymentioning

confidence: 99%

The physiologically difficult airway: an emerging concept

Myatra

Divatia

Brewster

2022

Current Opinion in Anaesthesiology

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Purpose of reviewThe physiologically difficult airway is one in which physiologic alterations in the patient increase the risk for cardiorespiratory and other complications during tracheal intubation and transition to positive pressure ventilation. This review will summarize the recent literature around the emerging concept of the physiologically difficult airway, describe its relevance and various patient types in which this entity is observed.Recent findingsPhysiologic derangements during airway management occur due acute illness, pre-existing disease, effects of anesthetic agents, and positive pressure ventilation. These derangements are especially recognized in critically ill patients, but can also occur in otherwise healthy patients including obese, pregnant and pediatric patients who have certain physiological alterations. Critically ill patients may have a physiologically difficult airway due to the presence of acute respiratory failure, hypoxemia, hypotension, severe metabolic acidosis, right ventricular failure, intracranial hypertension, and risk of aspiration of gastric contents during tracheal intubation.SummaryUnderstanding the physiological alterations and the risks involved in patients with a physiologically difficult airway is necessary to optimize the physiology and adopt strategies to avoid complications during tracheal intubation. Further research will help us better understand the optimal strategies to improve outcomes in these patients.

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“…Se ha demostrado que en ocasiones podría retrasar el momento de la intubación, sobre todo en quienes cursan con la descrita "hipoxemia feliz", casos de SDRA y COVID-19 con severa hipoxemia y sin taquipnea y/o disnea, que al parecer resultan de un comportamiento particular de este enfermedad, al existir inicialmente una distensibilidad pulmonar normal e incluso alta, alterando la respuesta normal del esfuerzo respiratorio (33,34). Se plantea que este periodo en que el paciente es expuesto a respiración espontánea podría ser perjudicial (aunque sin datos contundentes de aumento en la mortalidad), por medio de lo que se ha descrito como P-SILI (30,31,33,(35)(36)(37)(38)(39).…”

Section: Cnaf La Posibilidad De Una Nueva Estrategia De Oxigenaciónunclassified

Lesión autoinducida por el paciente en la pandemia por COVID-19, una situación de recursos limitados. Revisión de tema

Ramírez

Triana

2022

rev. colomb. neumol.

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La ventilación mecánica invasiva (VMI) es una estrategia importante de manejo en el paciente con síndrome de dificultad respiratoria aguda (SDRA). En la pandemia por COVID-19 los innumerables casos de SDRA han llevado al uso de otros dispositivos de oxigenación no invasivos, que han expuesto al paciente a mayor esfuerzo respiratorio, evidenciándose lo que se conoce como “lesión pulmonar autoinducida por el paciente” (P-SILI, por sus siglas en inglés). El objetivo de esta revisión es exponer la evidencia científica disponible relacionada con este fenómeno en el contexto de la pandemia por COVID-19. Se realizó una revisión narrativa de la literatura del tema mencionado; la búsqueda se realizó hasta septiembre de 2020 en las bases de datos Medline, Embase, Central y Google Académico y se seleccionaron los artículos más representativos. La VMI es fundamental en el tratamiento del SDRA, pero en manos inexpertas puede generar lesión pulmonar por diferentes mecanismos. Por otro lado, el uso de otros dispositivos de ventilación no invasiva como la cánula nasal de alto flujo, podrían favorecer la P-SILI, una condición que al parecer, perpetúa la inflamación y lesión pulmonar inicial al paciente en respiración espontánea. La información disponible aún es insuficiente.

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Focus on noninvasive respiratory support before and after mechanical ventilation in patients with acute respiratory failure

Cited by 17 publications

References 20 publications

Noninvasive respiratory support following extubation in critically ill adults: a systematic review and network meta-analysis

Noninvasive respiratory support following extubation in critically ill adults: a systematic review and network meta-analysis

The physiologically difficult airway: an emerging concept

Lesión autoinducida por el paciente en la pandemia por COVID-19, una situación de recursos limitados. Revisión de tema

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