Non-invasive ventilatory support and high-flow nasal oxygen as first-line treatment of acute hypoxemic respiratory failure and ARDS
Por:
Grieco, DL, Maggiore, SM, Roca, O, Spinelli, E, Patel, BK, Thille, AW, Barbas, CSV, De Acilu, MG, Cutuli, SL, Bongiovanni, F, Amato, M, Frat, JP, Mauri, T, Kress, JP, Mancebo, J, Antonelli, M
Publicada:
1 ago 2021
Ahead of Print:
1 jul 2021
Resumen:
The role of non-invasive respiratory support (high-flow nasal oxygen and noninvasive ventilation) in the management of acute hypoxemic respiratory failure and acute respiratory distress syndrome is debated. The oxygenation improvement coupled with lung and diaphragm protection produced by non-invasive support may help to avoid endotracheal intubation, which prevents the complications of sedation and invasive mechanical ventilation. However, spontaneous breathing in patients with lung injury carries the risk that vigorous inspiratory effort, combined or not with mechanical increases in inspiratory airway pressure, produces high transpulmonary pressure swings and local lung overstretch. This ultimately results in additional lung damage (patient self-inflicted lung injury), so that patients intubated after a trial of noninvasive support are burdened by increased mortality. Reducing inspiratory effort by high-flow nasal oxygen or delivery of sustained positive end-expiratory pressure through the helmet interface may reduce these risks. In this physiology-to-bedside review, we provide an updated overview about the role of noninvasive respiratory support strategies as early treatment of hypoxemic respiratory failure in the intensive care unit. Noninvasive strategies appear safe and effective in mild-to-moderate hypoxemia (PaO2/FiO(2) > 150 mmHg), while they can yield delayed intubation with increased mortality in a significant proportion of moderate-to-severe (PaO2/FiO(2) <= 150 mmHg) cases. High-flow nasal oxygen and helmet noninvasive ventilation represent the most promising techniques for first-line treatment of severe patients. However, no conclusive evidence allows to recommend a single approach over the others in case of moderate-to-severe hypoxemia. During any treatment, strict physiological monitoring remains of paramount importance to promptly detect the need for endotracheal intubation and not delay protective ventilation.
Filiaciones:
Grieco, DL:
Fdn Policlin Univ A Gemelli IRCCS, Dept Emergency Intens Care Med & Anesthesia, Rome, Italy
Univ Cattolica Sacro Cuore, Fdn Policlin Univ A Gemelli IRCCS, Dept Anesthesiol & Intens Care Med, I-00168 Rome, Italy
Maggiore, SM:
SS Annunziata Hosp, Dept Anesthesiol Crit Care Med & Emergency, Chieti, Italy
Gabriele DAnnunzio Univ Chieti Pescara, Univ Dept Innovat Technol Med & Dent, Chieti, Italy
Roca, O:
Hosp Univ Vall Hebron, Inst Recerca VallDHebron, Serv Med Intens, Barcelona, Spain
Inst Salud Carlos III, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
Spinelli, E:
Fdn IRCCS Ca Granda Maggiore Policlin Hosp, Dept Anesthesia Crit Care & Emergency, Milan, Italy
Patel, BK:
Univ Chicago, Sect Pulm & Crit Care, Dept Med, Chicago, IL USA
Thille, AW:
Ctr Hosp Univ CHU Poitiers, Med Intens Reanimat, Poitiers, France
Univ Poitiers, Ctr DInvest Clin 1402, INSERM, Alive, Poitiers, France
Barbas, CSV:
Univ Sao Paulo, Div Pulm & Crit Care, Sao Paulo, Brazil
Albert Einstein Hosp, Intens Care Unit, Sao Paulo, Brazil
De Acilu, MG:
Hosp Univ Vall Hebron, Inst Recerca VallDHebron, Serv Med Intens, Barcelona, Spain
Univ Autonoma Barcelona, Dept Med, Bellaterra, Spain
Cutuli, SL:
Fdn Policlin Univ A Gemelli IRCCS, Dept Emergency Intens Care Med & Anesthesia, Rome, Italy
Univ Cattolica Sacro Cuore, Fdn Policlin Univ A Gemelli IRCCS, Dept Anesthesiol & Intens Care Med, I-00168 Rome, Italy
Bongiovanni, F:
Fdn Policlin Univ A Gemelli IRCCS, Dept Emergency Intens Care Med & Anesthesia, Rome, Italy
Univ Cattolica Sacro Cuore, Fdn Policlin Univ A Gemelli IRCCS, Dept Anesthesiol & Intens Care Med, I-00168 Rome, Italy
Amato, M:
Univ Sao Paulo, Heart Inst Incor, Lab Pneumol LIM 09, Disciplina Pneumol,Hosp Clin,Fac Med, Sao Paulo, Brazil
Frat, JP:
Ctr Hosp Univ CHU Poitiers, Med Intens Reanimat, Poitiers, France
Univ Poitiers, Ctr DInvest Clin 1402, INSERM, Alive, Poitiers, France
Mauri, T:
Fdn IRCCS Ca Granda Maggiore Policlin Hosp, Dept Anesthesia Crit Care & Emergency, Milan, Italy
Univ Milan, Dept Pathophysiol & Transplantat, Milan, Italy
Kress, JP:
Fdn IRCCS Ca Granda Maggiore Policlin Hosp, Dept Anesthesia Crit Care & Emergency, Milan, Italy
Mancebo, J:
Hosp Univ Santa Creu & St Pau, Serv Med Intens, Barcelona, Spain
Antonelli, M:
Fdn Policlin Univ A Gemelli IRCCS, Dept Emergency Intens Care Med & Anesthesia, Rome, Italy
Univ Cattolica Sacro Cuore, Fdn Policlin Univ A Gemelli IRCCS, Dept Anesthesiol & Intens Care Med, I-00168 Rome, Italy
Green Published, Bronze
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