Non-invasive Ventilation and High Flow Nasal Therapy in Acute Respiratory Failure: 2019 Novelties

Abstract

There is strong evidence suggesting use of non-invasive ventilation in patients with severe exacerbation of chronic obstructive pulmonary disease, while use of high-flow nasal therapy in this indication is promising. However, current data suggest that non-invasive ventilation provides limited benefit in de novo acute respiratory failure, and specifically in immunocompromised patients. In this indication, high-flow nasal therapy is increasingly used, but new studies are needed to confirm its superiority over standard oxygen or non-invasive ventilation. In patients undergoing planned extubation, high-flow nasal therapy is effective in preventing re-intubation in patients at lower risk for this complication, while the combination of both non-invasive ventilation and high-flow nasal therapy appears the best strategy for those at higher risk for post-extubation respiratory failure. Finally, providing supplemental oxygen and ventilation from the start of pre-oxygenation until laryngoscopy could be the most effective approach to preventing life-threatening hypoxaemia for patients undergoing endotracheal intubation.