Management of acute hypercapnic respiratory failure

Pisani, Lara; Corcione, Nadia; Nava, Stefano

doi:10.1097/mcc.0000000000000269

Cited by 27 publications

(21 citation statements)

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“…Thanks to the accumulated body of scientific evidence, NPPV has become the first-choice ventilator technique in specific aetiologies underlying ARF, such as acidotic hypercapnic chronic obstructive pulmonary disease (COPD) exacerbation, cardiogenic pulmonary oedema, severe hypoxaemia in immunosuppression conditions and facilitation in transition from invasive mechanical ventilation (IMV) to spontaneous breathing in chronic hypercapnic patients [1,[6][7][8]. In fact, clinicians who do not apply NPPV in these "golden" clinical indications within the right time-frame and setting may be banned for malpractice.…”

Section: Introductionmentioning

confidence: 99%

Noninvasive ventilation in acute respiratory failure: which recipe for success?

2018

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Noninvasive positive-pressure ventilation (NPPV) to treat acute respiratory failure has expanded tremendously over the world in terms of the spectrum of diseases that can be successfully managed, the locations of its application and achievable goals.The turning point for the successful expansion of NPPV is its ability to achieve the same physiological effects as invasive mechanical ventilation with the avoidance of the life-threatening risks correlated with the use of an artificial airway.Cardiorespiratory arrest, extreme psychomotor agitation, severe haemodynamic instability, nonhypercapnic coma and multiple organ failure are absolute contraindications for NPPV. Moreover, pitfalls of NPPV reduce its rate of success; consistently, a clear plan of what to do in case of NPPV failure should be considered, especially for patients managed in unprotected setting. NPPV failure is likely to be reduced by the application of integrated therapeutic tools in selected patients handled by expert teams.In conclusion, NPPV has to be considered as a rational art and not just as an application of science, which requires the ability of clinicians to both choose case-by-case the best "ingredients" for a "successful recipe" ( patient selection, interface, ventilator, interface, ) and to avoid a delayed intubation if the ventilation attempt fails.

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Section: Introductionmentioning

confidence: 99%

Noninvasive ventilation in acute respiratory failure: which recipe for success?

2018

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“…Since the first pioneering studies of noninvasive ventilation in critical care in the late 1980s [ 1 – 3 ] thousands of studies and manuscripts have been published on this topic exploring different clinical applications, modalities, interfaces and comparisons with other therapies [ 4 , 5 ]. Its effectiveness has been proven for common clinical conditions in critical care, such as cardiogenic pulmonary edema (CPE) and exacerbation of chronic obstructive pulmonary disease (COPD) [ 4 – 7 ], as well as for ventilatory support for patients with ventilatory pump failure and to prevent extubation failure [ 8 – 10 ]. However, although extensively studied, some aspects remain controversial such as its role in hypoxemic “de novo” respiratory failure, the best interface and ventilatory modality to optimize patient-ventilator interaction and comfort and side effects (e.g.…”

Section: Introductionmentioning

confidence: 99%

Ten important articles on noninvasive ventilation in critically ill patients and insights for the future: A report of expert opinions

et al. 2017

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BackgroundNoninvasive ventilation is used worldwide in many settings. Its effectiveness has been proven for common clinical conditions in critical care such as cardiogenic pulmonary edema and chronic obstructive pulmonary disease exacerbations.Since the first pioneering studies of noninvasive ventilation in critical care in the late 1980s, thousands of studies and articles have been published on this topic. Interestingly, some aspects remain controversial (e.g. its use in de-novo hypoxemic respiratory failure, role of sedation, self-induced lung injury). Moreover, the role of NIV has recently been questioned and reconsidered in light of the recent reports of new techniques such as high-flow oxygen nasal therapy.MethodsWe conducted a survey among leading experts on NIV aiming to 1) identify a selection of 10 important articles on NIV in the critical care setting 2) summarize the reasons for the selection of each study 3) offer insights on the future for both clinical application and research on NIV.ResultsThe experts selected articles over a span of 26 years, more clustered in the last 15 years. The most voted article studied the role of NIV in acute exacerbation chronic pulmonary disease. Concerning the future of clinical applications for and research on NIV, most of the experts forecast the development of innovative new interfaces more adaptable to patients characteristics, the need for good well-designed large randomized controlled trials of NIV in acute “de novo” hypoxemic respiratory failure (including its comparison with high-flow oxygen nasal therapy) and the development of software-based NIV settings to enhance patient-ventilator synchrony.ConclusionsThe selection made by the experts suggests that some applications of NIV in critical care are supported by solid data (e.g. COPD exacerbation) while others are still waiting for confirmation. Moreover, the identified insights for the future would lead to improved clinical effectiveness, new comparisons and evaluation of its role in still “lack of full evidence” clinical settings.Electronic supplementary materialThe online version of this article (10.1186/s12871-017-0409-0) contains supplementary material, which is available to authorized users.

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“…The management of ARF may require an "escalation therapeutic strategy" based on the application of a wide range of ventilatory and non-ventilatory interventions (figure 1) [1, 4]. The rationale for applying these artificial supports is essentially to buy time for the aetiological therapy to reverse the cause of the acute decompensation of the respiratory system while avoiding/minimising the potential lung injuring effects of therapeutic interventions, such as ventilator-induced lung injury.…”

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confidence: 99%

“…pump failure) an imbalance exists between the load imposed on the respiratory muscles and the capacity of the muscle pump [1]. This category mainly includes patients with acute exacerbation of chronic obstructive pulmonary disease (COPD), as well as patients with neuro-miopathies, chest wall deformities and obesity.…”

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Highlights in acute respiratory failure

Scala

Heunks

2018

Eur Respir Rev

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@ERSpublications ARF management requires an escalation therapeutic strategy based on application of a wide range of ventilatory and non-ventilatory interventions; there are many unanswered questions that need to be addressed in the near future http://ow.ly/xbPi30iUP2y Acute respiratory failure (ARF) is a devastating condition for patients that results from either impaired function of the respiratory muscle pump or from dysfunction of the lung. ARF is a challenging field for clinicians working both within and outside the intensive care unit (ICU) and respiratory high dependency care unit environment because this heterogeneous syndrome is associated with a high hospital morbidity and mortality rate, ethical issues in managing end of life decisions and increased consumption of healthcare resources.In acute hypercapnic respiratory failure (i.e. pump failure) an imbalance exists between the load imposed on the respiratory muscles and the capacity of the muscle pump [1]. This category mainly includes patients with acute exacerbation of chronic obstructive pulmonary disease (COPD), as well as patients with neuro-miopathies, chest wall deformities and obesity. The in-hospital mortality of patients hospitalised for COPD exacerbation is 2-8% (up to 15% for ICU patients), with a 1-year mortality of 22-43%. Readmissions after hospitalisation for an exacerbation are frequent events, ranging from 14% to 16% in the first month after discharge and 25-58% in the first year [2].Acute hypoxaemic failure covers miscellanea of causes of lung damage including acute cardiogenic pulmonary oedema, pneumonia and trauma. Acute respiratory distress syndrome (ARDS) is a frequent cause of severe hypoxaemia. This clinical syndrome is characterised by acute inflammatory lung injury, associated with increased pulmonary vascular permeability, increased lung weight, and loss of aerated lung tissue [3]. In its most severe form (arterial oxygen tension/inspiratory oxygen fraction <100 mmHg), hospital mortality is ∼42% [3]. The insight in the pathophysiology of acute hypoxaemic failure has improved over the past decade. This has important consequences for treatment and monitoring of patients with ARF.The management of ARF may require an "escalation therapeutic strategy" based on the application of a wide range of ventilatory and non-ventilatory interventions (figure 1) [1, 4]. The rationale for applying these artificial supports is essentially to buy time for the aetiological therapy to reverse the cause of the acute decompensation of the respiratory system while avoiding/minimising the potential lung injuring effects of therapeutic interventions, such as ventilator-induced lung injury. In noninvasive ventilation (NIV) a dedicated interface is used, while with invasive mechanical ventilation (IMV) assistance is provided through an endotracheal tube or tracheostomy. New therapeutic options include high-flow nasal cannula [5], noninvasive and invasive cough assist strategies, high-frequency chest wall oscillation, and

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Management of acute hypercapnic respiratory failure

Cited by 27 publications

References 77 publications

Noninvasive ventilation in acute respiratory failure: which recipe for success?

Noninvasive ventilation in acute respiratory failure: which recipe for success?

Ten important articles on noninvasive ventilation in critically ill patients and insights for the future: A report of expert opinions

Highlights in acute respiratory failure

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