Non-invasive ventilation in hypoxemic acute respiratory failure: is it still possible?

Girault, Christophe; Ferrer, Miquel; Torres, Antoni

doi:10.1007/s00134-016-4661-4

Cited by 5 publications

(5 citation statements)

References 20 publications

(34 reference statements)

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“…Excessive TV and high transpulmonary pressure could potentially promote ventilator-induced lung injuries associated with detrimental outcomes. [ 27 ] However, the difference between the setup and the delivered TV (6.11 ± 0.27 vs 8.63 ± 1.41 ml/kg) was observed in our study most likely explained by the patients' own inspiratory effort. This is an important message that targeted-volume NIV mode is not totally risk free, and surveillance is still required.…”

Section: Discussioncontrasting

confidence: 57%

Targeted-Volume Noninvasive Ventilation Reduces Extubation Failure in Postextubated Medical Intensive Care Unit Patients: A Randomized Controlled Trial

Thanthitaweewat

Muntham

Chirakalwasan

2018

Indian Journal of Critical Care Medicine

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Purpose:Till date, the benefit of using noninvasive ventilation (NIV) routinely after extubation to prevent reintubation has been conflicting. We aim to demonstrate the effect of targeted-volume NIV for the prevention of reintubation and extubation failure after planned extubation in medical intensive care unit (ICU) patients.Study Design:This was a prospective, randomized controlled study.Materials and Methods:Patients on invasive mechanical ventilation for more than 48 hrs for acute respiratory failure, who were ready for extubation, were randomized into targeted-volume NIV (intervention group) or oxygen mask (controlled group) immediately after extubation and continuously for 24 hrs.Results:A total of 58 patients were enrolled in this study. The targeted-volume NIV group was observed to have a trend toward lower reintubation rate within 48 hrs compared to oxygen mask group (0% vs. 17.2%; P = 0.052). Extubation failure rate within 48 hrs was significantly lower in targeted-volume NIV group compared to oxygen mask group (0% vs. 41.38%; P < 0.001). There was a trend toward lower ICU length of stay (6[5] days vs. 10[8] days (median interquartile range [IQR]); P = 0.053) as well as shorter hospital length of stay after extubation (10[19] days vs. 18[15] days (median [IQR]); P = 0.059). There were no differences in the incidence of ventilator-associated pneumonia (VAP)/hospital-acquired pneumonia (HAP) (6.90% vs. 20.69%;P = 0.253) and 28 day-mortality (13.79% vs. 20.69%; P = 0.487).Conclusions:Our study is the first study to demonstrate the benefit of application of targeted-volume NIV immediately after extubation in reducing extubation failure rate. There was a trend toward lowering reintubation rate and shorter ICU length of stay and hospital length of stay after extubation in mixed medical ICU patients.

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Section: Discussioncontrasting

confidence: 57%

Targeted-Volume Noninvasive Ventilation Reduces Extubation Failure in Postextubated Medical Intensive Care Unit Patients: A Randomized Controlled Trial

Thanthitaweewat

Muntham

Chirakalwasan

2018

Indian Journal of Critical Care Medicine

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“…33 To our knowledge, respiratory failure caused by this pathogenesis usually responds poorly to NIV. 33,34 In addition, the etiologic causes of hypoxemic AHRF, such as ARDS, pneumonia, postoperative AHRF, and thoracic trauma, might impact the outcomes of those selected patients. 35 Previous studies demonstrated that subjects with ARDS did not benefit from NIV.…”

Section: Discussionmentioning

confidence: 99%

Noninvasive Ventilation as a Weaning Strategy in Subjects with Acute Hypoxemic Respiratory Failure

Shan

Pang²,

Wang³

et al. 2020

Respir Care

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BACKGROUND: Weaning through noninvasive ventilation (NIV) after early extubation may facilitate invasive ventilation withdrawal and reduce related complications in patients with hypercapnic respiratory failure. However, the effects of NIV weaning are uncertain in patients with acute hypoxemic respiratory failure (AHRF). We aimed to investigate whether NIV weaning could reduce hospital mortality and other outcomes compared with invasive weaning in subjects with hypoxemic AHRF. METHODS: We searched medical literature databases for relevant articles published from inception to February 2019. Randomized controlled trials that adopted NIV as a weaning strategy compared with invasive weaning in hypoxemic AHRF were included. The primary outcome was hospital mortality. The secondary outcomes included ICU mortality, the ICU stay, weaning time, duration of ventilation, extubation failure, and adverse events. RESULTS: Six relevant studies, which involved 718 subjects, were included. There was no significant effect of NIV weaning on hospital mortality compared with invasive weaning (risk ratio 0.94, 95% CI 0.65-1.36; P 5 .74), whereas there was a significant effect of NIV weaning on shortening the ICU stay (mean difference 23.95, 95% CI 26.49 to 21.40, P 5 .002) and on decreasing adverse events without affecting the weaning time (standardized MD 20.04, 95% CI 20.21 to 0.14; P 5 .68). CONCLUSIONS: The strategy of NIV weaning did not decrease hospital mortality in subjects with hypoxemic AHRF, but it did shorten the ICU lengths of stay and reduce adverse events.

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“…The authors identified a HACOR score >5 at one hour of NIV, which revealed a high risk of failure that remained at 12, 24 and 48 hours. Girault et al 10 have recognized the HACOR score as a useful tool to pinpoint patients with high risk of failure, however, for patients with AHRF, the HACOR score is not expected to reduce the rate of NIV failure. Both studies demonstrated that the mortality rate may be reduced when patients at high risk of failure undergo immediate intubation.…”

Section: Case Reportmentioning

confidence: 99%

“…Both studies demonstrated that the mortality rate may be reduced when patients at high risk of failure undergo immediate intubation. 9,10 Although NIV has been evidenced as a controversial practice for patients under investigation of H1N1, Dutra et al 11 reported the use of NIV performed with a conventional microprocessor-controlled, using a full-face mask in four female patients diagnosed with SARS, two of them infected with H1N1 virus. Improvement was observed in the respiratory pattern, SpO2, blood gas analysis, and X-ray.…”

Section: Case Reportmentioning

confidence: 99%

Noninvasive Mechanical Ventilation Management and Hacor Score in Acute Hypoxemic Respiratory Failure Induced by Influenza a (H1n1): a Case Report

Guerra

Vianna

Michelato

et al. 2023

REASE

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Influenza is a highly contagious, acute viral infection that affects the respiratory system, and causes global outbreak in humans. It is usually self-limited, may progress to severe acute respiratory syndrome (SARS), and eventually leads to acute hypoxemic respiratory failure (AHRF). The main objective was to describe a case report of careful management of NIV in SARS caused by influenza A H1N1 virus, using the HACOR score. The patient exhibited clinical, radiological and laboratory improvement after 4 days of NIV treatment. She was discharged from ICU after 7 days and from the hospital after 10 days. NIV in AHRF is feasible in well-selected patients. Special attention to ventilator settings should be taken particularly to the expired tidal volume, allowing less hospitalization time, orotracheal intubation complications, and therefore, reducing hospital costs. Under these conditions, the new HACOR score can be very useful to avoid unduly delay of intubation time and increased mortality.

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Non-invasive ventilation in hypoxemic acute respiratory failure: is it still possible?

Cited by 5 publications

References 20 publications

Targeted-Volume Noninvasive Ventilation Reduces Extubation Failure in Postextubated Medical Intensive Care Unit Patients: A Randomized Controlled Trial

Targeted-Volume Noninvasive Ventilation Reduces Extubation Failure in Postextubated Medical Intensive Care Unit Patients: A Randomized Controlled Trial

Noninvasive Ventilation as a Weaning Strategy in Subjects with Acute Hypoxemic Respiratory Failure

Noninvasive Mechanical Ventilation Management and Hacor Score in Acute Hypoxemic Respiratory Failure Induced by Influenza a (H1n1): a Case Report

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