Unmasking a Role for Noninvasive Ventilation in Early Acute Respiratory Distress Syndrome

Beitler, Jeremy R.; Owens, Robert L.; Malhotra, Atul

doi:10.1001/jama.2016.5987

Cited by 12 publications

(9 citation statements)

References 15 publications

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“…The rate of success of NIV with BiPAP S/T-AVAPS in the group of subjects with mild ARDS was 73.1% and 50% in subjects with moderate ARDS. These results did not differ from what has been reported in other studies in which NIV was used in ARDS [18,19]. The total rate of intubation was 34.2% while the mortality rate was 28.9%.…”

Section: Discussionsupporting

confidence: 52%

Use of noninvasive mechanical ventilation with pressure support guaranteed with average volume in de novo hypoxaemic respiratory failure. A pilot study

Claudett

Rodriguez

Briones-Claudett³

et al. 2018

Anaesthesiol Intensive Ther

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Background: This study was designed to determine the results associated with the use of noninvasive mechanical ventilation (NIV) using the BiPAP S/T-AVAPS ventilation strategy in subjects with mild to moderate de novo hypoxaemic respiratory failure. Methods: This is a prospective study that includes subjects with de novo hypoxaemic respiratory failure (not produced by acute exacerbations of COPD, chronic lung disease, or congestive heart failure) with mild to moderate PaO 2 /FiO 2 , who were admitted to the Intensive Care Unit (ICU) of Santa Maria Clinic in Guayaquil, Ecuador. Subjects were divided into two groups and compared according to their PaO 2 /FiO 2 : higher than 100 and up to 200 mm Hg (moderate ARDS) or between 200 and 300 mm Hg (mild ARDS) (both groups were ventilated with the BiPAP S/T-AVAPS strategy). Results: A total of 38 subjects were analysed in this study. The total rate of intubation was 34.2% while the mortality rate was 28.9%. Significant differences were observed when comparing success versus failure in exhaled tidal volumes heart rate (P = 0.04), peak inspired pressure (P < 0.001), PaO 2 (P < 0.001), SaO 2 (P < 0.002), PaO 2 /FiO 2 (P < 0.002), arterial blood pressure (P < 0.001), HR (P < 0.001), and inspiratory time (P = 0.029) measured at baseline and at 12-hour, 24-hour and 48-hour intervals. Conclusion: The BiPAP S/T-AVAPS ventilatory mode can be used in subjects with de novo hypoxaemic respiratory failure with special vigilance concerning exhaled tidal volumes and inspired pressure.

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Section: Discussionsupporting

confidence: 52%

Use of noninvasive mechanical ventilation with pressure support guaranteed with average volume in de novo hypoxaemic respiratory failure. A pilot study

Claudett

Rodriguez

Briones-Claudett³

et al. 2018

Anaesthesiol Intensive Ther

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“…Otherwise, invasive positive pressure ventilation and the related co-interventions carry their own risks: sedative infusions that predispose to delirium, decreased mobility that predisposes to neuromuscular weakness, and risk of ventilator-associated pneumonia, among other complications 175,176 . Noninvasive positive pressure ventilation improves oxygenation 177 and is used fairly often in patients with mild ARDS with unclear benefit on outcome 178 , although device interface may influence patient tolerance and efficacy 179,180 . High-flow oxygen (e.g.…”

Section: Managementmentioning

confidence: 99%

Acute respiratory distress syndrome

Matthay

Zemans

Zimmerman

et al. 2019

Nat Rev Dis Primers

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1,653

1,519

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The acute respiratory distress syndrome (ARDS) is a common cause of respiratory failure in critically ill patients and is defined by the acute onset of noncardiogenic pulmonary edema, hypoxemia, and the need for mechanical ventilation. ARDS occurs most often in the setting of pneumonia, sepsis, aspiration of gastric contents or severe trauma, and is present in ~10% of all intensive care unit patients worldwide. Despite some improvements over the past decades, mortality remains high at 30–40% in most studies. Pathologic specimens from patients with ARDS most frequently reveal diffuse alveolar damage, and laboratory studies have demonstrated both alveolar epithelial and lung endothelial injury, resulting in accumulation of protein-rich inflammatory edema fluid in the alveolar space. Diagnosis is based on consensus syndromic criteria, with recent proposed modifications for under-resourced settings and for pediatric patients. Patient management focuses on implementing a lung-protective ventilation strategy; no specific pharmacotherapies have been identified. Long-term outcomes of patients with ARDS are increasingly recognized as important research targets, as many patients survive ARDS only to suffer ongoing functional and/or psychologic sequelae. Future directions include efforts to facilitate earlier recognition of ARDS, prognostic and/or predictive enrichment in clinical studies to identify responsive subsets, and ongoing efforts to understand fundamental mechanisms of lung injury that may respond to specific treatments.

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“…The use of noninvasive ventilation is a controversial issue even in the care of nonobese patients with ARDS. [85][86][87] Indeed, the recent LUNG-SAFE study found that 15% of all patients with ARDS received noninvasive ventilation as a form of respiratory support. 88 In this study, noninvasive ventilation treatment failure occurred in approximately 20% of mild and 45% of moderate and severe ARDS cases, and failure was associated with >2-fold increase in hospital mortality as compared with those patients who did not fail.…”

Section: High-flow Nasal Cannula and Noninvasive Ventilationmentioning

confidence: 99%

Pathophysiology and Management of Acute Respiratory Distress Syndrome in Obese Patients

Umbrello

Fumagalli

Pesenti

et al. 2019

Semin Respir Crit Care Med

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A rising prevalence of obesity is reported over time and throughout the world. At the same time, the acute respiratory distress syndrome (ARDS) remains an important public health problem, accounting for approximately 10% of intensive care unit admissions and leading to significant hospital mortality. Even in the absence of acute illnesses, obesity affects respiratory mechanics and gas exchange in the setting of a restrictive disease. In the presence of ARDS, obesity adds various challenges to a safe and effective management of respiratory support. Difficult airway management, altered lung and chest wall physiology, and positional gas trapping are routinely encountered. The management of such difficult cases is generally empiric, as it is based on small-sized, physiologic studies or on suggestions from the general anesthesia literature. The present review focuses on those cases in which ARDS is coincident with obesity, with the aim of presenting treatment options based on the current evidence. The first part summarizes the epidemiology of obesity and ARDS. Then the diagnostic challenges due to obesity-related artifacts of the different imaging techniques will be presented. A subsequent, detailed description of the altered respiratory anatomy and physiology of obesity will provide help in selecting an optimal, individually tailored strategy of support. Furthermore, we will discuss how esophageal manometry should be used to adjust the settings of positive end-expiratory pressure and tidal volume; the challenges of prone positioning and extracorporeal support; and the optimal strategies for weaning from mechanical ventilation, including when and how to perform a tracheostomy.

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Unmasking a Role for Noninvasive Ventilation in Early Acute Respiratory Distress Syndrome

Cited by 12 publications

References 15 publications

Use of noninvasive mechanical ventilation with pressure support guaranteed with average volume in de novo hypoxaemic respiratory failure. A pilot study

Use of noninvasive mechanical ventilation with pressure support guaranteed with average volume in de novo hypoxaemic respiratory failure. A pilot study

Acute respiratory distress syndrome

Pathophysiology and Management of Acute Respiratory Distress Syndrome in Obese Patients

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