Noninvasive Ventilation and High-Flow Nasal Therapy Administration in Chronic Obstructive Pulmonary Disease Exacerbations

Ferrer, Miquel; Torres, Antoni

doi:10.1055/s-0040-1712101

Cited by 4 publications

(3 citation statements)

References 95 publications

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“…Im Wesentlichen wird der intrinsische PEEPi durch Einsatz des externen PEEP antagonisiert und durch die zusätzliche maschinelle Druckunterstützung die diaphragmale Atemarbeit reduziert 13 14 15 . Zusätzlich senkt der externe PEEP die zum Triggern der Druckunterstützung erforderliche inspiratorische Atemarbeit des Patienten 16 .…”

Section: Hyperkapnische Ariunclassified

S2k-Leitlinie Nichtinvasive Beatmung als Therapie der akuten respiratorischen Insuffizienz

Westhoff,

Neumann,

Geiseler

et al. 2023

Pneumologie

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ZusammenfassungDie Leitlinienaktualisierung zeigt die Vorteile sowie die Grenzen der NIV bei der Behandlung von akutem Atemversagen im klinischen Alltag und bei unterschiedlichen Indikationen auf.Die nichtinvasive Beatmung (NIV) hat einen hohen Stellenwert bei der Therapie des hyperkapnischen akuten Atemversagens, da sie die Aufenthaltsdauer und den Krankenhausaufenthalt auf der Intensivstation sowie die Mortalität deutlich reduziert.Patienten mit kardiopulmonalem Ödem und akutem Atemversagen sollten zusätzlich zu notwendigen kardiologischen Eingriffen mit kontinuierlichem positivem Atemwegsdruck (CPAP) und Sauerstoff behandelt werden. Dies sollte bereits präklinisch und in der Notaufnahme erfolgen.Bei anderen Formen des akuten hypoxämischen Atemversagens mit nur leicht bis mäßig gestörtem Gasaustausch (PaO2/FiO2 > 150 mmHg) ergibt sich kein signifikanter Vor- oder Nachteil gegenüber nasaler Sauerstoff-High-Flow-Therapie (HFNO). Bei schweren Formen des ARDS ist die NIV mit einer hohen Rate an Behandlungsversagen und Mortalität verbunden, insbesondere in Fällen mit NIV-Versagen und verzögerter Intubation.Zur Präoxygenierung vor der Intubation sollte NIV verwendet werden. Bei Risikopatienten wird eine NIV empfohlen, um Extubationsversagen zu reduzieren. Im Entwöhnungsprozess von der invasiven Beatmung reduziert NIV das Risiko einer Reintubation bei hyperkapnischen Patienten wesentlich. NIV gilt in der Palliativversorgung als nützlich zur Reduzierung von Dyspnoe und zur Verbesserung der Lebensqualität, hier aber in Konkurrenz zur HFNO, das als komfortabler gilt. Mittlerweile wird die NIV auch im präklinischen Bereich empfohlen, insbesondere bei hyperkapnischem Atemversagen und beim Lungenödem.Bei entsprechender Überwachung auf einer Intensivstation kann NIV auch bei pädiatrischen Patienten mit akuter Ateminsuffizienz erfolgreich eingesetzt werden.

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Section: Hyperkapnische Ariunclassified

S2k-Leitlinie Nichtinvasive Beatmung als Therapie der akuten respiratorischen Insuffizienz

Westhoff,

Neumann,

Geiseler

et al. 2023

Pneumologie

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“…Cortegiani et al 14 used non-invasive ventilation and HFNC to treat patients with COPD and acute hypercapnia exacerbation, and the results confirmed that the effects of both methods were equivalent. Research by Miquel Ferrer et al 15 has also confirmed that HFNC has high application value in patients with COPD, can improve gas exchange, alleviate breathing difficulties, and has important significance in reducing disease mortality and tracheal intubation rates. Our findings are consistent with the above studies.…”

Section: Discussionmentioning

confidence: 93%

Effect of budesonide/glycopyrrolate/formoterol fumarate metered dose inhaler combined with nasal high-flow nasal cannula on elderly patients with COPD and respiratory failure

Hu,

2023

Pak J Med Sci

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Objective: To explore the clinical effect of budesonide/glycopyrrolate/formoterol fumarate metered dose inhaler (BGF MDI) combined with high-flow nasal cannula (HFNC) in the treatment of elderly patients with chronic obstructive pulmonary disease (COPD) and respiratory failure. Methods: The clinical records of 94 elderly patients with COPD and respiratory failure who were treated in Yongkang First People’s Hospital from February 2022 to January 2023 were retrospectively selected. Among them, 46 patients received HFNC alone (Control-group) and 48 patients received HFNC combined with BGF MDI (Study-group). The treatment effect, arterial blood gas status, pulmonary function, and acute physiology and chronic health evaluation (APACHE) II score before and after treatment were analyzed in both groups. Results: The total efficacy of treatment in the Study-group (95.8%) was higher than that in the Control-group (78.3%) (P<0.05). After treatment, the partial pressure of arterial carbon dioxide (PaCO2), residual volume, and APACHE II scores in the two groups decreased compared to those before treatment, with the Study-group lower overall. However, arterial oxygen saturation (SaO2), oxygen partial pressure (PaO2), the percentage of peak expiratory flow (PEF), and forced expiratory volume in one second (FEV1) as percent of predicted (%FEV1) were higher than before treatment, and higher in the Study-group (P<0.05). Conclusions: Compared with HFNC alone, BGF MDI combined with HFNC can effectively regulate the arterial blood gas status of elderly patients with COPD and respiratory failure, restore pulmonary function, and improve the overall treatment effect. doi: https://doi.org/10.12669/pjms.40.3.8395 How to cite this: Hu F, Lv F. Effect of budesonide/glycopyrrolate/formoterol fumarate metered dose inhaler combined with nasal high-flow nasal cannula on elderly patients with COPD and respiratory failure. Pak J Med Sci. 2024;40(3):---------. doi: https://doi.org/10.12669/pjms.40.3.8395 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…Based on those potential mechanisms above, it is reasonable to use HFNC in AECOPD patients [ 1 ], but its efficacy and safety in such patients are not clear [ 16 ]. In order to unite the advantages of NIV and HFNC, we designed this trial to evaluate the effect of HFNC with sequential NIV versus NIV alone on patients with mild-to-moderate AECOPD.…”

Section: Introductionmentioning

confidence: 99%

High-flow nasal cannula therapy with sequential noninvasive ventilation versus noninvasive ventilation alone as the initial ventilatory strategy in acute COPD exacerbations: study protocol for a randomized controlled trial

Liu

Walline

Zhu

et al. 2022

Trials

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Background Noninvasive ventilation (NIV) is the recommended mode of ventilation used in acute respiratory failure secondary to an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Recent data has shown that high-flow nasal cannula (HFNC) treatment can be an alternative for patients with hypercapnic respiratory failure. The purpose of this study is to evaluate HFNC with sequential NIV versus NIV alone as the initial ventilatory strategy in AECOPD. Methods This investigator-initiated, unblinded, single center, randomized controlled trial will be conducted in the emergency department, emergency intensive care unit, or respiratory intensive care unit of a tertiary-care urban teaching hospital. A total of 66 patients will be enrolled and randomized into the intervention group (HFNC with sequential NIV) or the control group (NIV group). The primary endpoint will be the mean difference in PaCO2 from baseline to 24 h after randomization. Secondary endpoints include the mean difference in PaCO2 from baseline to 6, 12, and 18 h, as well as the dyspnea score, overall discomfort score, rate of treatment failure, respiratory rate, rate of endotracheal intubation, length of hospital stay, and mortality. Discussion Taking the advantages of both HFNC and NIV on AECOPD patients into account, we designed this clinical trial to investigate the combination of these ventilatory strategies. This trial will help us understand how HFNC with sequential NIV compares to NIV alone in treating AECOPD patients. Trial registration ChiCTR2100054809.

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Noninvasive Ventilation and High-Flow Nasal Therapy Administration in Chronic Obstructive Pulmonary Disease Exacerbations

Cited by 4 publications

References 95 publications

S2k-Leitlinie Nichtinvasive Beatmung als Therapie der akuten respiratorischen Insuffizienz

S2k-Leitlinie Nichtinvasive Beatmung als Therapie der akuten respiratorischen Insuffizienz

Effect of budesonide/glycopyrrolate/formoterol fumarate metered dose inhaler combined with nasal high-flow nasal cannula on elderly patients with COPD and respiratory failure

High-flow nasal cannula therapy with sequential noninvasive ventilation versus noninvasive ventilation alone as the initial ventilatory strategy in acute COPD exacerbations: study protocol for a randomized controlled trial

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