Effects of non-invasive respiratory supports on inspiratory effort in moderate-severe COVID-19 patients. A randomized physiological study

Schifino, Gioacchino; Vega, María Laura; Pisani, Lara; Prediletto, Irene; Catalanotti, Vito; Comellini, Vittoria; Bassi, Ilaria; Zompatori, Maurizio; Ranieri, Marco; Nava, Stefano

doi:10.1016/j.ejim.2022.04.012

Cited by 19 publications

(20 citation statements)

References 42 publications

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“…Moreover, only NIV demonstrated to significantly reduce the tidal change in esophageal pressure (ΔPes) and so the inspiratory effort, leaving transpulmonary pressure constant, under the limit that have been considered safe in order to prevent lung damage. The authors also reported better gas exchange during CPAP and NIV with higher PaO2/FiO2 in comparison with VM [1] .…”

mentioning

confidence: 78%

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Non-invasive respiratory supports on inspiratory effort in Covid-19: how and when is it matter of selection?

Flora

Mollica²,

Fiorentino³

et al. 2022

European Journal of Internal Medicine

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mentioning

confidence: 78%

“…In addition, the tree patients of the study of Schifino et al who failed NRS approach had higher value of inspiratory effort that did not show a reduction during NIV trial before intubation [1] . The conclusions of the study, in our opinion, underline the importance of early monitoring of respiratory mechanics during NRS treatment.…”

mentioning

confidence: 89%

Non-invasive respiratory supports on inspiratory effort in Covid-19: how and when is it matter of selection?

Flora

Mollica²,

Fiorentino³

et al. 2022

European Journal of Internal Medicine

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“…For the same PEEP level, the major difference between CPAP and NIV in the capability of the latter to best reduce inspiratory effort. From a theoretical standpoint, in hypoxemic patients, CPAP could be preferred in case the inspiratory effort before treatment start is low (< 10 cmH 2 O), while NIV mostly benefits patients with high inspiratory effort (> 10 cmH 2 O) [ 53 ].…”

Section: Helmet Supportmentioning

confidence: 99%

Helmet noninvasive support for acute hypoxemic respiratory failure: rationale, mechanism of action and bedside application

Cesarano

Grieco

Michi

et al. 2022

Ann. Intensive Care

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Introduction Helmet noninvasive support may provide advantages over other noninvasive oxygenation strategies in the management of acute hypoxemic respiratory failure. In this narrative review based on a systematic search of the literature, we summarize the rationale, mechanism of action and technicalities for helmet support in hypoxemic patients. Main results In hypoxemic patients, helmet can facilitate noninvasive application of continuous positive-airway pressure or pressure-support ventilation via a hood interface that seals at the neck and is secured by straps under the arms. Helmet use requires specific settings. Continuous positive-airway pressure is delivered through a high-flow generator or a Venturi system connected to the inspiratory port of the interface, and a positive end-expiratory pressure valve place at the expiratory port of the helmet; alternatively, pressure-support ventilation is delivered by connecting the helmet to a mechanical ventilator through a bi-tube circuit. The helmet interface allows continuous treatments with high positive end-expiratory pressure with good patient comfort. Preliminary data suggest that helmet noninvasive ventilation (NIV) may provide physiological benefits compared to other noninvasive oxygenation strategies (conventional oxygen, facemask NIV, high-flow nasal oxygen) in non-hypercapnic patients with moderate-to-severe hypoxemia (PaO2/FiO2 ≤ 200 mmHg), possibly because higher positive end-expiratory pressure (10–15 cmH2O) can be applied for prolonged periods with good tolerability. This improves oxygenation, limits ventilator inhomogeneities, and may attenuate the potential harm of lung and diaphragm injury caused by vigorous inspiratory effort. The potential superiority of helmet support for reducing the risk of intubation has been hypothesized in small, pilot randomized trials and in a network metanalysis. Conclusions Helmet noninvasive support represents a promising tool for the initial management of patients with severe hypoxemic respiratory failure. Currently, the lack of confidence with this and technique and the absence of conclusive data regarding its efficacy render helmet use limited to specific settings, with expert and trained personnel. As per other noninvasive oxygenation strategies, careful clinical and physiological monitoring during the treatment is essential to early identify treatment failure and avoid delays in intubation.

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“…Although the respiratory rate and FiO 2 did not vary between groups, the patient effort may be reduced using BPAP, thereby mitigating self-induced lung injury. 6 …”

mentioning

confidence: 99%

Noninvasive Ventilation Reduces Rates of Intubation Compared With High Flow Oxygenation in Patients With Severe COVID-19

Gordon

Bracey²

2023

Annals of Emergency Medicine

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Effects of non-invasive respiratory supports on inspiratory effort in moderate-severe COVID-19 patients. A randomized physiological study

Cited by 19 publications

References 42 publications

Non-invasive respiratory supports on inspiratory effort in Covid-19: how and when is it matter of selection?

Non-invasive respiratory supports on inspiratory effort in Covid-19: how and when is it matter of selection?

Helmet noninvasive support for acute hypoxemic respiratory failure: rationale, mechanism of action and bedside application

Noninvasive Ventilation Reduces Rates of Intubation Compared With High Flow Oxygenation in Patients With Severe COVID-19

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