Physiological Comparison of High-Flow Nasal Cannula and Helmet Noninvasive Ventilation in Acute Hypoxemic Respiratory Failure

Grieco, Domenico Luca; Menga, Luca Salvatore; Raggi, Valeria; Bongiovanni, Filippo; Anzellotti, Gian Marco; Tanzarella, Eloisa Sofia; Bocci, Maria Grazia; Mercurio, G; Dell’Anna, Antonio Maria; Eleuteri, Davide; Bello, Giuseppe; Maviglia, Riccardo; Conti, Giorgio; Maggiore, Salvatore Maurizio; Antonelli, Massimo

doi:10.1164/rccm.201904-0841oc

Cited by 135 publications

(148 citation statements)

References 66 publications

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“…Of interest, the inspiratory effort at baseline as expressed by ΔPes did not show a significant correlation with the severity of respiratory failure. These findings are in line with data reported in a recent physiological study by Grieco and colleagues ( 21 ), in which ΔPes was unrelated to oxygenation impairment during helmet NIV and high-flow oxygen treatment. Our data further underline the inability of Pa O 2 /F i O 2 ratio alone to identify patients with harmful respiratory drive.…”

Section: Discussionsupporting

confidence: 93%

Early Inspiratory Effort Assessment by Esophageal Manometry Predicts Noninvasive Ventilation Outcome in De Novo Respiratory Failure. A Pilot Study

Tonelli

Fantini

Tabbì

et al. 2020

Am J Respir Crit Care Med

190

204

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Rationale: The role of inspiratory effort still has to be determined as a potential predictor of noninvasive mechanical ventilation (NIV) failure in acute hypoxic de novo respiratory failure. Objectives: To explore the hypothesis that inspiratory effort might be a major determinant of NIV failure in these patients. Methods: Thirty consecutive patients with acute hypoxic de novo respiratory failure admitted to a single center and candidates for a 24-hour NIV trial were enrolled. Clinical features, tidal change in esophageal pressure (DPes), tidal change in dynamic transpulmonary pressure (DPL), expiratory VT, and respiratory rate were recorded on admission and 2-4 to 12-24 hours after NIV start and were tested for correlation with outcomes. Measurements and Main Results: DPes and DPes/DPL ratio were significantly lower 2 hours after NIV start in patients who successfully completed the NIV trial (n = 18) compared with those who needed endotracheal intubation (n = 12) (median [interquartile range], 11 [8-15] cm H 2 O vs. 31.5 [30-36] cm H 2 O; P , 0.0001), whereas other variables differed later. DPes was not related to other predictors of NIV failure at baseline. NIV-induced reduction in DPes of 10 cm H 2 O or more after 2 hours of treatment was strongly associated with avoidance of intubation and represented the most accurate predictor of treatment success (odds ratio, 15; 95% confidence interval, 2.8-110; P = 0.001 and area under the curve, 0.97; 95% confidence interval, 0.91-1; P , 0.0001). Conclusions: The magnitude of inspiratory effort relief as assessed by DPes variation within the first 2 hours of NIV was an early and accurate predictor of NIV outcome at 24 hours. Clinical trial registered with www.clinicaltrials.gov (NCT 03826797).

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Section: Discussionsupporting

confidence: 93%

Early Inspiratory Effort Assessment by Esophageal Manometry Predicts Noninvasive Ventilation Outcome in De Novo Respiratory Failure. A Pilot Study

Tonelli

Fantini

Tabbì

et al. 2020

Am J Respir Crit Care Med

190

204

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“…ст. применение НВЛ с помощью шлема предпочтительнее ВПКТ с точки зрения оптимизации оксигенации и снижения инспираторного усилия, особенно у пациентов с более тяжелой гипоксемией и высокой работой дыхания [44].…”

Section: преимущества неинвазивной вентиляции легких при гипоксемичесunclassified

Non-invasive ventilation in patients with novel coronavirus infection COVID-19

Avdeev

2020

Pulʹmonologiâ (Mosk.)

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In the early stages of the COVID-19 pandemic, many guidelines for the management of patients with new coronavirus infection did not include recommendations for the use of non-invasive ventilation (NIV) due to the concerns that NIV could be accompanied by high tidal volumes that could cause lung damage. In addition, there was an opinion that NIV increases the risk of spreading bioaerosol containing the SARS-CoV-2 virus. At the same time, NIV was widely used in real clinical practice in the management of severe patients with COVID-19 (in some countries, up to 60% of all respiratory support methods). The accumulated experience demonstrates that when applying NIV, the risk of contamination with viral infections is minimized with adequate use of personal protective equipment. To date, the results of a limited number of studies about effectiveness of NIV in hypoxemic acute respiratory failure (ARF) in patients with COVID-19 are available. In most studies, the need for tracheal intubation and hospital mortality, were on average, 20 – 30%, that suggests a fairly high effectiveness of NIV in ARF in patients with COVID-19.

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“…Andererseits konnte bei Patienten mit einem ARDS (Horowitz-Quotient < 200) gezeigt werden, dass ein Tidalvolumen von 9,5 ml/kg KG in den ersten 4 Stunden ein NIV-Versagen prädizierte [9,10]. Einige Autoren empfehlen daher eher den Einsatz einer PEEP-Beatmung vorzugsweise mittels Helm [11,12]; der Vorrat an Helmen auf dem Markt während Pandemiezeiten war jedoch ausgesprochen gering.…”

Section: Diskussionunclassified

ECMO als Therapie des schweren Lungenversagens bei COVID-19

Schmauß¹,

Müller²,

Schwamborn

et al. 2020

Pneumologie

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ZusammenfassungWir berichten über den Fall einer 60-jährigen Patientin mit fortgeschrittenem schwerem Lungenversagen bei COVID-19-assoziierter Pneumonie. Die Patientin erhielt zuerst 2 Tage eine (Highflow-)Sauerstoff-Therapie (HFNC) und CPAP, anschließend musste sie intubiert und invasiv beatmet werden. Nach dem Scheitern einer invasiven Beatmung mit schwerster Hypoxämie erfolgte der Anschluss an eine vv-ECMO. Diese wurde über 24 Tage durchgeführt. Die prognostischen Parameter zeigten ab Tag 14 eine günstige Tendenz. Nach Beendigung der ECMO und insgesamt 11 Tagen stundenweiser assistierter Beatmung über Tracheostoma und Sauerstoff (1 l/min) konnte die Patientin in die Rehabilitationsbehandlung verlegt werden. Die letzte Röntgenthoraxaufnahme zeigte eine nahezu vollständige Rückbildung der initialen ausgedehnten beidseitigen Verschattungen. Unser Fall zeigt, dass auch nach einer prolongierten ECMO-Therapie eine Ausheilung der schweren COVID-assoziierten Lungenschäden möglich ist.

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Physiological Comparison of High-Flow Nasal Cannula and Helmet Noninvasive Ventilation in Acute Hypoxemic Respiratory Failure

Cited by 135 publications

References 66 publications

Early Inspiratory Effort Assessment by Esophageal Manometry Predicts Noninvasive Ventilation Outcome in De Novo Respiratory Failure. A Pilot Study

Early Inspiratory Effort Assessment by Esophageal Manometry Predicts Noninvasive Ventilation Outcome in De Novo Respiratory Failure. A Pilot Study

Non-invasive ventilation in patients with novel coronavirus infection COVID-19

ECMO als Therapie des schweren Lungenversagens bei COVID-19

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