The Changing Landscape of Noninvasive Ventilation in the Intensive Care Unit

Patel, Bhakti; Kress, John P.

doi:10.1001/jama.2015.12401

Cited by 9 publications

(5 citation statements)

References 15 publications

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“…8–12 cmH 2 O) and lower pressure support values with fewer air leaks and interruptions. 39 , 41 However, only two small sample size RCTs 20 , 26 and one observational study 17 comparing helmet NIV and HFNC were included in the analysis, and there was no study to comparing the differences of mode and ventilator parameters between helmet NIV and face mask NIV. High-quality RCTs in COVID-19 patients comparing helmet NIV with both face mask NIV and HFNC are needed, including patient-important outcomes and attention to possible adverse events.…”

Section: Discussionmentioning

confidence: 99%

Comparison between high-flow nasal cannula and noninvasive ventilation in COVID-19 patients: a systematic review and meta-analysis

Peng

Dai

Zhao

et al. 2022

Ther Adv Respir Dis

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Background: High-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) are important treatment approaches for acute hypoxemic respiratory failure (AHRF) in coronavirus disease 2019 (COVID-19) patients. However, the differential impact of HFNC versus NIV on clinical outcomes of COVID-19 is uncertain. Objectives: We assessed the effects of HFNC versus NIV (interface or mode) on clinical outcomes of COVID-19. Methods: We searched PubMed, EMBASE, Web of Science, Scopus, MedRxiv, and BioRxiv for randomized controlled trials (RCTs) and observational studies (with a control group) of HFNC and NIV in patients with COVID-19-related AHRF published in English before February 2022. The primary outcome of interest was the mortality rate, and the secondary outcomes were intubation rate, PaO2/FiO2, intensive care unit (ICU) length of stay (LOS), hospital LOS, and days free from invasive mechanical ventilation [ventilator-free day (VFD)]. Results: In all, 23 studies fulfilled the selection criteria, and 5354 patients were included. The mortality rate was higher in the NIV group than the HFNC group [odds ratio (OR) = 0.66, 95% confidence interval (CI): 0.51–0.84, p = 0.0008, I2 = 60%]; however, in this subgroup, no significant difference in mortality was observed in the NIV-helmet group (OR = 1.21, 95% CI: 0.63–2.32, p = 0.57, I2 = 0%) or NIV-continuous positive airway pressure (CPAP) group (OR = 0.77, 95% CI: 0.51–1.17, p = 0.23, I2 = 65%) relative to the HFNC group. There were no differences in intubation rate, PaO2/FiO2, ICU LOS, hospital LOS, or days free from invasive mechanical ventilation (VFD) between the HFNC and NIV groups. Conclusion: Although mortality was lower with HFNC than NIV, there was no difference in mortality between HFNC and NIV on a subgroup of helmet or CPAP group. Future large sample RCTs are necessary to prove our findings. Registration: This systematic review and meta-analysis protocol was prospectively registered with PROSPERO (no. CRD42022321997).

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Section: Discussionmentioning

confidence: 99%

Comparison between high-flow nasal cannula and noninvasive ventilation in COVID-19 patients: a systematic review and meta-analysis

Peng

Dai

Zhao

et al. 2022

Ther Adv Respir Dis

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“…To date, the most frequently used interface in RCTs has been face mask NIV, although helmet NIV may be more comfortable and allow the application of a more "protective" ventilation with higher PEEP (i.e., 8-12 cmH2O) and lower pressure support values with fewer air leaks and interruptions. (62,63) Clinicians now have the option of HFNC and NIV with a variety of interfaces for use in AHRF; however, the recent ERS/ATS TF did not offer a recommendation on the use of NIV for de novo AHRF, noting that the majority of the studies used COT as a comparator. (23)…”

Section: Justificationmentioning

confidence: 99%

ERS clinical practice guidelines: high-flow nasal cannula in acute respiratory failure

et al. 2021

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BackgroundHigh-flow nasal cannula (HFNC) has become a frequently used non-invasive form of respiratory support in acute settings, however evidence supporting its use has only recently emerged. These guidelines provide evidence-based recommendations for the use of HFNC alongside other noninvasive forms of respiratory support in adults with acute respiratory failure (ARF).Materials and methodologyThe European Respiratory Society Task Force panel included expert clinicians and methodologists in pulmonology and intensive care medicine. The Task Force used the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methods to summarise evidence and develop clinical recommendations for the use of HFNC alongside conventional oxygen therapy (COT) and non-invasive ventilation (NIV) for the management of adults in acute settings with ARF.ResultsThe Task Force developed 8 conditional recommendations, suggesting using: 1) HFNC over COT in hypoxemic ARF, 2) HFNC over NIV in hypoxemic ARF, 3)HFNC over COT during breaks from NIV, 4) either HFNC or COT in post-operative patients at low risk of pulmonary complications, 5) either HFNC or NIV in post-operative patients at high risk of pulmonary complications, 6) HFNC over COT in non-surgical patients at low risk of extubation failure, 7) NIV over HFNC for patients at high risk of extubation failure unless there are relative or absolute contraindications to NIV, 8) trialling NIV prior to use of HFNC in patients with chronic obstructive pulmonary disease (COPD) and hypercapnic ARF.ConclusionsHFNC is a valuable intervention in adults with ARF. These conditional recommendations can assist clinicians in choosing the most appropriate form of non-invasive respiratory support to provide to patients in different acute settings.

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“…Patients who are intubated typically have a higher mortality rate, estimated at approximately 50%. 11 Most patients do not require mechanical ventilation; however, owing to the disruption of activities of daily living and mobility, all hospitalized patients are at some degree of risk of NVHAP. 12 In NIV, positive pressure is applied within a mask to achieve alveolar expansion and recruitment, but the process also distends the esophagus and stomach.…”

Section: Noninvasive Ventilationmentioning

confidence: 99%

Oral Care in Critically Ill Patients Requiring Noninvasive Ventilation: An Evidence-Based Review

Johnny

Drury

et al. 2021

Critical Care Nurse

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Topic Hospital-acquired pneumonia commonly develops after 48 hours of hospitalization and can be divided into non–ventilator-acquired and ventilator-acquired pneumonia. Prevention of non–ventilator-acquired pneumonia requires a multimodal approach. Implementation of oral care bundles can reduce the incidence of ventilator-acquired pneumonia, but the literature on oral care in other populations is limited. Clinical Relevance Use of noninvasive ventilation is increasing owing to positive outcomes. The incidence of non–ventilator-acquired pneumonia is higher in patients receiving noninvasive ventilation than in the general hospitalized population but remains lower than that of ventilator-acquired pneumonia. Non–ventilator-acquired pneumonia increases mortality risk and hospital length of stay. Purpose To familiarize nurses with the evidence regarding oral care in critically ill patients requiring noninvasive ventilation. Content Covered No standard of oral care exists for patients requiring noninvasive ventilation owing to variation in study findings, definitions, and methods. Oral care decreases the risk of hospital-acquired pneumonia and improves comfort. Nurses perform oral care less often for nonintubated patients, as it is perceived as primarily a comfort measure. The potential risks of oral care for patients receiving noninvasive ventilation have not been explored. Further research is warranted before this practice can be fully implemented. Conclusion Oral care is a common preventive measure for non–ventilator-acquired pneumonia and may improve comfort. Adherence to oral care is lower for patients not receiving mechanical ventilation. Further research is needed to identify a standard of care for oral hygiene for patients receiving noninvasive ventilation and assess the risk of adverse events.

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The Changing Landscape of Noninvasive Ventilation in the Intensive Care Unit

Cited by 9 publications

References 15 publications

Comparison between high-flow nasal cannula and noninvasive ventilation in COVID-19 patients: a systematic review and meta-analysis

Comparison between high-flow nasal cannula and noninvasive ventilation in COVID-19 patients: a systematic review and meta-analysis

ERS clinical practice guidelines: high-flow nasal cannula in acute respiratory failure

Oral Care in Critically Ill Patients Requiring Noninvasive Ventilation: An Evidence-Based Review

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