Non-invasive ventilation for acute hypoxemic respiratory failure, including COVID-19.
J Intensive Med
; 3(1): 11-19, 2023 Jan 31.
Article
in English
| MEDLINE | ID: covidwho-2244689
ABSTRACT
Optimal initial non-invasive management of acute hypoxemic respiratory failure (AHRF), of both coronavirus disease 2019 (COVID-19) and non-COVID-19 etiologies, has been the subject of significant discussion. Avoidance of endotracheal intubation reduces related complications, but maintenance of spontaneous breathing with intense respiratory effort may increase risks of patients' self-inflicted lung injury, leading to delayed intubation and worse clinical outcomes. High-flow nasal oxygen is currently recommended as the optimal strategy for AHRF management for its simplicity and beneficial physiological effects. Non-invasive ventilation (NIV), delivered as either pressure support or continuous positive airway pressure via interfaces like face masks and helmets, can improve oxygenation and may be associated with reduced endotracheal intubation rates. However, treatment failure is common and associated with poor outcomes. Expertise and knowledge of the specific features of each interface are necessary to fully exploit their potential benefits and minimize risks. Strict clinical and physiological monitoring is necessary during any treatment to avoid delays in endotracheal intubation and protective ventilation. In this narrative review, we analyze the physiological benefits and risks of spontaneous breathing in AHRF, and the characteristics of tools for delivering NIV. The goal herein is to provide a contemporary, evidence-based overview of this highly relevant topic.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Type of study:
Etiology study
/
Prognostic study
/
Reviews
Language:
English
Journal:
J Intensive Med
Year:
2023
Document Type:
Article
Affiliation country:
J.jointm.2022.08.006
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