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Cevik E, Dogan D, Gumus K, Can D, Acar YA. Is disposable continuous positive airway pressure system effective for the management of acute hypercapnic respiratory failure? Ir J Med Sci 2023; 192:1931-1937. [PMID: 36243821 DOI: 10.1007/s11845-022-03189-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/06/2022] [Indexed: 12/01/2022]
Abstract
AIM This study aimed to investigate the effectiveness of disposable continuous positive airway pressure (DCPAP) system in decreasing the partial pressure of carbon dioxide (PaCO2) levels in patients with acute hypercapnic respiratory failure (AHRF). MATERIAL AND METHODS This retrospective observational study included patients treated in the emergency department (ED) with respiratory distress and PaCO2 > 45 mmHg. Patients were divided into two groups (DCPAP and non-DCPAP), depending on the treatment received to treat AHRF. The difference between the baseline PaCO2 levels in the first blood gas obtained from patients at the time of admission and the follow-up blood gas after treatment. Then, the calculated PaCO2 decrease was divided by the time elapsed to obtain the rate of decrease in PaCO2 levels in mmHg/min. The statistical analyses were performed using SPSS version 18.0 software. A p value of < 0.05 was considered statistically significant. RESULTS A total of 61 patients were included in the study, 31 patients in the DCPAP group and 30 patients in the non-DCPAP group. The mean age of the patients was 74.03 ± 10.04, and the male/female was 23/38. The study demonstrated a statistically significant difference between the DCPAP and non-DCPAP groups in terms of PaCO2 decreasing rate, and it was found to be twice higher in the DCPAP group (0.11 ± 0.07 mmHg/min) than in the non-DCPAP group (0.05 ± 0.06 mmHg/min). CONCLUSION The study demonstrated that the treatment of AHRF patients with a DCPAP provides a faster decrease in PaCO2 levels in hypercapnic patients compared to standard medical therapy alone.
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Affiliation(s)
- Erdem Cevik
- Faculty of Medicine, Department of Emergency Medicine, University of Health Sciences, 34668, Uskudar, Istanbul, Turkey.
| | - Deniz Dogan
- Gulhane School of Medicine, Department of Chest Medicine and Tuberculosis, University of Health Sciences, Ankara, Turkey
| | - Kursat Gumus
- Gulhane School of Medicine, Department of Emergency Medicine, University of Health Sciences, Ankara, Turkey
| | - Derya Can
- Department of Emergency Medicine, Halil Sıvgın Cubuk State Hospital, Ankara, Turkey
| | - Yahya A Acar
- Gulhane School of Medicine, Department of Emergency Medicine, University of Health Sciences, Ankara, Turkey
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Ovtcharenko N, Ho E, Alhazzani W, Cortegiani A, Ergan B, Scala R, Sotgiu G, Chaudhuri D, Oczkowski S, Lewis K. High-flow nasal cannula versus non-invasive ventilation for acute hypercapnic respiratory failure in adults: a systematic review and meta-analysis of randomized trials. Crit Care 2022; 26:348. [DOI: 10.1186/s13054-022-04218-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/22/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
Non-invasive ventilation (NIV) with bi-level positive pressure ventilation is a first-line intervention for selected patients with acute hypercapnic respiratory failure. Compared to conventional oxygen therapy, NIV may reduce endotracheal intubation, death, and intensive care unit length of stay (LOS), but its use is often limited by patient tolerance and treatment failure. High-flow nasal cannula (HFNC) is a potential alternative treatment in this patient population and may be better tolerated.
Research question
For patients presenting with acute hypercapnic respiratory failure, is HFNC an effective alternative to NIV in reducing the need for intubation?
Methods
We searched EMBASE, MEDLINE, and the Cochrane library from database inception through to October 2021 for randomized clinical trials (RCT) of adults with acute hypercapnic respiratory failure assigned to receive HFNC or NIV. The Cochrane risk-of-bias tool for randomized trials was used to assess risk of bias. We calculated pooled relative risks (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with corresponding 95% confidence intervals (CI) using a random-effects model.
Results
We included eight RCTs (n = 528) in the final analysis. The use of HFNC compared to NIV did not reduce the risk of our primary outcome of mortality (RR 0.86, 95% CI 0.48–1.56, low certainty), or our secondary outcomes including endotracheal intubation (RR 0.80, 95% CI 0.46–1.39, low certainty), or hospital LOS (MD − 0.82 days, 95% CI − 1.83–0.20, high certainty). There was no difference in change in partial pressure of carbon dioxide between groups (MD − 1.87 mmHg, 95% CI − 5.34–1.60, moderate certainty).
Interpretation
The current body of evidence is limited in determining whether HFNC may be either superior, inferior, or equivalent to NIV for patients with acute hypercapnic respiratory failure given imprecision and study heterogeneity. Further studies are needed to better understand the effect of HFNC on this population.
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Almanza-Hurtado A, Polanco Guerra C, Martínez-Ávila MC, Borré-Naranjo D, Rodríguez-Yanez T, Dueñas-Castell C. Hypercapnia from Physiology to Practice. Int J Clin Pract 2022; 2022:2635616. [PMID: 36225533 PMCID: PMC9525762 DOI: 10.1155/2022/2635616] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/28/2022] [Accepted: 09/15/2022] [Indexed: 11/18/2022] Open
Abstract
Acute hypercapnic ventilatory failure is becoming more frequent in critically ill patients. Hypercapnia is the elevation in the partial pressure of carbon dioxide (PaCO2) above 45 mmHg in the bloodstream. The pathophysiological mechanisms of hypercapnia include the decrease in minute volume, an increase in dead space, or an increase in carbon dioxide (CO2) production per sec. They generate a compromise at the cardiovascular, cerebral, metabolic, and respiratory levels with a high burden of morbidity and mortality. It is essential to know the triggers to provide therapy directed at the primary cause and avoid possible complications.
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Tousif S, Avendaño-Capriles CA, Shamim K, Shah H, Wali S, Barkat R. Agreement and Correlation Between Arterial and Venous Blood pH, PO2, PCO2, Lactate, and HCO3. Cureus 2021; 13:e18401. [PMID: 34729278 PMCID: PMC8556762 DOI: 10.7759/cureus.18401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 11/14/2022] Open
Abstract
Retracted
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Affiliation(s)
| | | | | | | | - Sher Wali
- Indus Hospital Research Center, Indus Hospital and Health Network, Karachi, PAK
| | - Rahil Barkat
- Indus Hospital Research Center, Indus Hospital and Health Network, Karachi, PAK
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Consales G, Zamidei L, Turani F, Atzeni D, Isoni P, Boscolo G, Saggioro D, Resta MV, Ronco C. Combined Renal-Pulmonary Extracorporeal Support with Low Blood Flow Techniques: A Retrospective Observational Study (CICERO Study). Blood Purif 2021; 51:299-308. [PMID: 34237722 DOI: 10.1159/000517280] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 05/19/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Critically ill patients with acute respiratory failure frequently present concomitant lung and kidney injury, within a multiorgan failure condition due to local and systemic mediators. To face this issue, extracorporeal carbon dioxide removal (ECCO2R) systems have been integrated into continuous renal replacement therapy (CRRT) platforms to provide a combined organ support, with efficient clearance of CO2 with very low extracorporeal blood flows (<400 mL/min). OBJECTIVES To evaluate efficacy and safety of combined ECCO2R-CRRT support with PrismaLung®-Prismaflex® in patients affected by hypercapnic respiratory acidosis associated with AKI in a second level intensive care unit. METHODS We carried out a retrospective observational study enrolling patients submitted to PrismaLung®-Prismaflex® due to mild to moderate acute respiratory distress syndrome (ARDS) or acute exacerbation of chronic obstructive pulmonary disease (aeCOPD). The primary endpoints were the shift to protective ventilation and extubation of mechanically ventilated patients and the shift to invasive mechanical ventilation of patients receiving noninvasive ventilation (NIV). Clinical-laboratoristic data and operational characteristics of ECCO2R-CRRT were recorded. RESULTS Overall, 12/17 patients on mechanical ventilation shifted to protective ventilation, CO2 clearance was satisfactorily maintained during the whole observational period, and pH was rapidly corrected. Treatment prevented NIV failure in 4 out of 5 patients. No treatment-related complications were recorded. CONCLUSION ECCO2R-CRRT was effective and safe in patients with aeCOPD and ARDS associated with AKI.
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Affiliation(s)
- Guglielmo Consales
- Emergency and Critical Care Department, S. Stefano Hospital, Prato, Italy
| | - Lucia Zamidei
- Emergency and Critical Care Department, S. Stefano Hospital, Prato, Italy
| | - Franco Turani
- Anaesthesia and Critical Care Department, Aurelia and European Hospital, Rome, Italy
| | - Diego Atzeni
- Cardioanaesthesia and Cardiosurgical Intensive Care Unit, Cardiovascular Department, San Michele Hospital, AO Brotzu, Cagliari, Italy
| | - Paolo Isoni
- Anaesthesia and Critical Care Unit, PO Santissima Trinità, ASSL Cagliari, Cagliari, Italy
| | - Gloria Boscolo
- Anaesthesia and Critical Care Department, dell'Angelo Hospital, Venice, Italy
| | - Debora Saggioro
- Anaesthesia and Critical Care Department, dell'Angelo Hospital, Venice, Italy
| | - Marco Vittorio Resta
- Anaesthesia and Critical Care Department, IRCCS San Donato Milanese Policlinic, San Donato Milanese, Milan, Italy
| | - Claudio Ronco
- DIMED, San Bortolo Hospital, University of Padova and International Renal Research Institute (IRRIV), Vicenza, Italy
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6
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Luján M, Peñuelas Ó, Cinesi Gómez C, García-Salido A, Moreno Hernando J, Romero Berrocal A, Gutiérrez Ibarluzea I, Masa Jiménez JF, Mas A, Carratalá Perales JM, Gaboli M, Concheiro Guisán A, García Fernández J, Escámez J, Parrilla Parrilla J, Farrero Muñoz E, González M, Heili-Frades SB, Sánchez Quiroga MÁ, Rialp Cervera G, Hernández G, Sánchez Torres A, Uña R, Ortolà CF, Ferrer Monreal M, Egea Santaolalla C. Summary of recommendations and key points of the consensus of Spanish scientific societies (SEPAR, SEMICYUC, SEMES; SECIP, SENEO, SEDAR, SENP) on the use of non-invasive ventilation and high-flow oxygen therapy with nasal cannulas in adult, pediatric, and neonatal patients with severe acute respiratory failure. Med Intensiva 2021; 45:298-312. [PMID: 34059220 DOI: 10.1016/j.medine.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/25/2020] [Indexed: 11/28/2022]
Abstract
Non-invasive respiratory support (NIRS) in adult, pediatric, and neonatal patients with acute respiratory failure (ARF) comprises two treatment modalities, non-invasive mechanical ventilation (NIMV) and high-flow nasal cannula (HFNC) therapy. However, experts from different specialties disagree on the benefit of these techniques in different clinical settings. The objective of this consensus was to develop a series of good clinical practice recommendations for the application of non-invasive support in patients with ARF, endorsed by all scientific societies involved in the management of adult and pediatric/neonatal patients with ARF. To this end, the different societies involved were contacted, and they in turn appointed a group of 26 professionals with sufficient experience in the use of these techniques. Three face-to-face meetings were held to agree on recommendations (up to a total of 71) based on a literature review and the latest evidence associated with 3 categories: indications, monitoring and follow-up of NIRS. Finally, the experts from each scientific society involved voted telematically on each of the recommendations. To classify the degree of agreement, an analogue classification system was chosen that was easy and intuitive to use and that clearly stated whether the each NIRS intervention should be applied, could be applied, or should not be applied.
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Affiliation(s)
- M Luján
- Servicio de Neumología, Hospital Universitari Parc Taulí de Sabadell, Sabadell, Barcelona; Universitat Autònoma de Barcelona, Barcelona; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Ó Peñuelas
- Servicio de Medicina Intensiva y Grandes Quemados, Hospital Universitario de Getafe, Getafe, Madrid; CIBER de Enfermedades Respiratorias (CIBERES), Madrid; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, Spain.
| | - C Cinesi Gómez
- Servicio de Urgencias, Hospital General Universitario Reina Sofía, Director del Máster en Medicina de Urgencias y Emergencias de la Universidad Católica de Murcia (UCAM), Murcia, Spain
| | - A García-Salido
- Servicio de Cuidados Intensivos Pediátricos e Investigador Posdoctoral en el Laboratorio de Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - J Moreno Hernando
- Servicio de Neonatología, Hospital Universitari Sant Joan de Déu, Barcelona, Spain
| | - A Romero Berrocal
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | | | - J F Masa Jiménez
- Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain
| | - A Mas
- Servei de Medicina Intensiva, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona; Hospital General d'Hospitalet, L'Hospitalet de Llobregat, Barcelona; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, Spain
| | - J M Carratalá Perales
- Servicio de Urgencias, Unidad de Corta Estancia, Hospital General Universitario, Alicante, Spain
| | - M Gaboli
- Neumología Pediátrica y Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - A Concheiro Guisán
- Unidad de Neonatología, Hospital Alvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - J García Fernández
- Servicio de Anestesia, Cuidados Críticos Quirúrgicos y Dolor, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | - J Escámez
- Servicio de Urgencias, Hospital Virgen de los Lirios, Alcoy, Alicante, Spain
| | - J Parrilla Parrilla
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - E Farrero Muñoz
- Servei de Pneumologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - M González
- Unidad de Sueño y Ventilación, Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de investigación Marqués de Valdecilla, IDIVAL, Santander, Cantabria, Spain
| | - S B Heili-Frades
- Neumología, Unidad de Cuidados Respiratorios Intermedios, Hospital Universitario Fundación Jiménez, Madrid; Díaz Quirón Salud. IIS. CIBERES, REVA Network, EMDOS, Spain
| | - M Á Sánchez Quiroga
- Servicio de Neumología, Hospital Virgen del Puerto de Plasencia, Plasencia, Cáceres; CIBER de Enfermedades Respiratorias (CIBERES), ISCIII, Madrid; Instituto Universitario de Investigación Biosanitaria en Extremadura (INUBE), Cáceres, Spain
| | - G Rialp Cervera
- Servicio de Medicina Intensiva, Hospital Universitari Son Llàtzer, Palma de Mallorca, Grupo de Trabajo de SEMICUYC de Insuficiencia Respiratoria Aguda, Spain
| | - G Hernández
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, Spain
| | - A Sánchez Torres
- Servicio de Neonatología, Hospital Universitario La Paz, Madrid, Spain
| | - R Uña
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, Spain
| | - C F Ortolà
- Sección Área de Cuidados Intensivos Quirúrgicos, Servicio de Anestesia y Cuidados Intensivos, Hospital Clínic, Barcelona, Spain
| | - M Ferrer Monreal
- Servei de Pneumologia, Institut del Tòrax, Hospital Clínic de Barcelona, IDIBAPS, CibeRes (CB06/06/0028), Universitat de Barcelona, Barcelona, Spain
| | - C Egea Santaolalla
- Unidad Funcional de Sueño, Hospital Universitario Araba, OSI Araba, Vitoria-Gasteiz, Araba, Spain
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7
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Luján M, Peñuelas Ó, Cinesi Gómez C, García-Salido A, Moreno Hernando J, Romero Berrocal A, Gutiérrez Ibarluzea I, Masa Jiménez JF, Mas A, Carratalá Perales JM, Gaboli M, Concheiro Guisán A, García Fernández J, Escámez J, Parrilla Parrilla J, Farrero Muñoz E, González M, Heili-Frades SB, Sánchez Quiroga MÁ, Rialp Cervera G, Hernández G, Sánchez Torres A, Uña R, Ferrando Ortolà C, Ferrer Monreal M, Egea Santaolalla C. Summary of Recommendations and Key Points of the Consensus of Spanish Scientific Societies (SEPAR, SEMICYUC, SEMES; SECIP, SENEO, SEDAR, SENP) on the Use of Non-Invasive Ventilation and High-Flow Oxygen Therapy with Nasal Cannulas in Adult, Pediatric, and Neonatal Patients With Severe Acute Respiratory Failure. Arch Bronconeumol 2021; 57:415-427. [PMID: 34088393 DOI: 10.1016/j.arbr.2021.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/25/2020] [Indexed: 11/30/2022]
Abstract
Non-invasive respiratory support (NIRS) in adult, pediatric, and neonatal patients with acute respiratory failure (ARF) comprises two treatment modalities, non-invasive mechanical ventilation (NIMV) and high-flow nasal cannula (HFNC) therapy. However, experts from different specialties disagree on the benefit of these techniques in different clinical settings. The objective of this consensus was to develop a series of good clinical practice recommendations for the application of non-invasive support in patients with ARF, endorsed by all scientific societies involved in the management of adult and pediatric/neonatal patients with ARF. To this end, the different societies involved were contacted, and they in turn appointed a group of 26 professionals with sufficient experience in the use of these techniques. Three face-to-face meetings were held to agree on recommendations (up to a total of 71) based on a literature review and the latest evidence associated with 3 categories: indications, monitoring and follow-up of NIRS. Finally, the experts from each scientific society involved voted telematically on each of the recommendations. To classify the degree of agreement, an analog classification system was chosen that was easy and intuitive to use and that clearly stated whether the each NIRS intervention should be applied, could be applied, or should not be applied.
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Affiliation(s)
- Manel Luján
- Servicio de Neumología, Hospital Universitari Parc Taulí de Sabadell, Sabadell, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | - Óscar Peñuelas
- Servicio de Medicina Intensiva y Grandes Quemados, Hospital Universitario de Getafe, Getafe, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, Spain
| | - César Cinesi Gómez
- Servicio de Urgencias, Hospital General Universitario Reina Sofía, Director del Máster en Medicina de Urgencias y Emergencias de la Universidad Católica de Murcia (UCAM), Murcia, Spain
| | - Alberto García-Salido
- Servicio de Cuidados Intensivos Pediátricos e Investigador Posdoctoral en el Laboratorio de Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Antonio Romero Berrocal
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | | | - Juan Fernando Masa Jiménez
- Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain
| | - Arantxa Mas
- Servei de Medicina Intensiva, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain; Hospital General d'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, Spain
| | | | - Mirella Gaboli
- Neumología Pediátrica y Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Javier García Fernández
- Servicio de Anestesia, Cuidados Críticos Quirúrgicos y Dolor, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | - Joaquín Escámez
- Servicio de Urgencias, Hospital Virgen de los Lirios, Alcoy, Alicante, Spain
| | - Julio Parrilla Parrilla
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Eva Farrero Muñoz
- Servei de Pneumologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Mónica González
- Unidad de Sueño y Ventilación, Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de investigación Marqués de Valdecilla, IDIVAL, Santander, Cantabria, Spain
| | - Sarah Béatrice Heili-Frades
- Neumología, Unidad de Cuidados Respiratorios Intermedios, Hospital Universitario Fundación Jiménez, Madrid, Spain; Díaz Quirón Salud. IIS. CIBERES, REVA Network, EMDOS, Spain
| | - María Ángeles Sánchez Quiroga
- Servicio de Neumología, Hospital Virgen del Puerto de Plasencia, Plasencia, Cáceres, Spain; CIBER de Enfermedades Respiratorias (CIBERES), ISCIII, Madrid, Spain; Instituto Universitario de Investigación Biosanitaria en Extremadura (INUBE), Cáceres, Spain
| | - Gemma Rialp Cervera
- Servicio de Medicina Intensiva, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain; Grupo de Trabajo de SEMICUYC de Insuficiencia Respiratoria Aguda, Spain
| | - Gonzalo Hernández
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, Spain; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, Spain
| | | | - Rafael Uña
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, Spain
| | - Carlos Ferrando Ortolà
- Sección Área de Cuidados Intensivos Quirúrgicos, Servicio de Anestesia y Cuidados Intensivos, Hospital Clínic, Barcelona, Spain
| | - Miquel Ferrer Monreal
- Servei de Pneumologia, Institut del Tòrax, Hospital Clínic de Barcelona, IDIBAPS, CibeRes (CB06/06/0028), Universitat de Barcelona, Barcelona, Spain
| | - Carlos Egea Santaolalla
- Unidad Funcional de Sueño, Hospital Universitario Araba, OSI Araba, Vitoria-Gasteiz, Araba, Spain
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Cutuli SL, Grieco DL, Menga LS, De Pascale G, Antonelli M. Noninvasive ventilation and high-flow oxygen therapy for severe community-acquired pneumonia. Curr Opin Infect Dis 2021; 34:142-150. [PMID: 33470666 PMCID: PMC9698117 DOI: 10.1097/qco.0000000000000715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW We review the evidence on the use of noninvasive respiratory supports (noninvasive ventilation and high-flow nasal cannula oxygen therapy) in patients with acute respiratory failure because of severe community-acquired pneumonia. RECENT FINDINGS Noninvasive ventilation is strongly advised for the treatment of hypercapnic respiratory failure and recent evidence justifies its use in patients with hypoxemic respiratory failure when delivered by helmet. Indeed, such interface allows alveolar recruitment by providing high level of positive end-expiratory pressure, which improves hypoxemia. On the other hand, high-flow nasal cannula oxygen therapy is effective in patients with hypoxemic respiratory failure and some articles support its use in patients with hypercapnia. However, early identification of noninvasive respiratory supports treatment failure is crucial to prevent delayed orotracheal intubation and protective invasive mechanical ventilation. SUMMARY Noninvasive ventilation is the first-line therapy in patients with acute hypercapnic respiratory failure because of pneumonia. Although an increasing amount of evidence investigated the application of noninvasive respiratory support to hypoxemic respiratory failure, the optimal ventilatory strategy in this setting is uncertain. Noninvasive mechanical ventilation delivered by helmet and high-flow nasal cannula oxygen therapy appear as promising tools but their role needs to be confirmed by future research.
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Affiliation(s)
- Salvatore Lucio Cutuli
- Dipartimento di Scienza dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8
- Facoltà di Medicina e Chirurgia ‘Agostino Gemelli’, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome, Italy
| | - Domenico Luca Grieco
- Dipartimento di Scienza dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8
- Facoltà di Medicina e Chirurgia ‘Agostino Gemelli’, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome, Italy
| | - Luca Salvatore Menga
- Dipartimento di Scienza dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8
- Facoltà di Medicina e Chirurgia ‘Agostino Gemelli’, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome, Italy
| | - Gennaro De Pascale
- Dipartimento di Scienza dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8
- Facoltà di Medicina e Chirurgia ‘Agostino Gemelli’, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome, Italy
| | - Massimo Antonelli
- Dipartimento di Scienza dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8
- Facoltà di Medicina e Chirurgia ‘Agostino Gemelli’, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome, Italy
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9
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Luján M, Peñuelas Ó, Cinesi Gómez C, García-Salido A, Moreno Hernando J, Romero Berrocal A, Gutiérrez Ibarluzea I, Masa Jiménez JF, Mas A, Carratalá Perales JM, Gaboli M, Concheiro Guisán A, García Fernández J, Escámez J, Parrilla Parrilla J, Farrero Muñoz E, González M, Heili-Frades SB, Sánchez Quiroga MÁ, Rialp Cervera G, Hernández G, Sánchez Torres A, Uña R, Ferrando Ortolà C, Ferrer Monreal M, Egea Santaolalla C. Summary of Recommendations and Key Points of the Consensus of Spanish Scientific Societies (SEPAR, SEMICYUC, SEMES; SECIP, SENEO, SEDAR, SENP) on the Use of Non-Invasive Ventilation and High-Flow Oxygen Therapy with Nasal Cannulas in Adult, Pediatric, and Neonatal Patients with Severe Acute Respiratory Failure. Arch Bronconeumol 2020. [PMID: 33309418 DOI: 10.1016/j.arbres.2020.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Non-invasive respiratory support (NIRS) in adult, pediatric, and neonatal patients with acute respiratory failure (ARF) comprises two treatment modalities, non-invasive mechanical ventilation (NIMV) and high-flow nasal cannula (HFNC) therapy. However, experts from different specialties disagree on the benefit of these techniques in different clinical settings. The objective of this consensus was to develop a series of good clinical practice recommendations for the application of non-invasive support in patients with ARF, endorsed by all scientific societies involved in the management of adult and pediatric/neonatal patients with ARF. To this end, the different societies involved were contacted, and they in turn appointed a group of 26 professionals with sufficient experience in the use of these techniques. Three face-to-face meetings were held to agree on recommendations (up to a total of 71) based on a literature review and the latest evidence associated with 3 categories: indications, monitoring and follow-up of NIRS. Finally, the experts from each scientific society involved voted telematically on each of the recommendations. To classify the degree of agreement, an analogue classification system was chosen that was easy and intuitive to use and that clearly stated whether the each NIRS intervention should be applied, could be applied, or should not be applied.
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Affiliation(s)
- Manel Luján
- Servicio de Neumología, Hospital Universitari Parc Taulí de Sabadell, Sabadell, Barcelona; Universitat Autònoma de Barcelona, Barcelona; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, España.
| | - Óscar Peñuelas
- Servicio de Medicina Intensiva y Grandes Quemados, Hospital Universitario de Getafe, Getafe, Madrid; CIBER de Enfermedades Respiratorias (CIBERES), Madrid; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, España
| | - César Cinesi Gómez
- Servicio de Urgencias, Hospital General Universitario Reina Sofía. Director del Máster en Medicina de Urgencias y Emergencias de la Universidad Católica de Murcia (UCAM), Murcia, España
| | - Alberto García-Salido
- Servicio de Cuidados Intensivos Pediátricos e Investigador Posdoctoral en el Laboratorio de Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | | | - Antonio Romero Berrocal
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | | | - Juan Fernando Masa Jiménez
- Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, España
| | - Arantxa Mas
- Servei de Medicina Intensiva, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona; Hospital General d'Hospitalet, L'Hospitalet de Llobregat, Barcelona; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, España
| | | | - Mirella Gaboli
- Neumología Pediátrica y Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | - Javier García Fernández
- Servicio de Anestesia, Cuidados Críticos Quirúrgicos y Dolor, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | - Joaquín Escámez
- Servicio de Urgencias, Hospital Virgen de los Lirios, Alcoy, Alicante, España
| | - Julio Parrilla Parrilla
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Eva Farrero Muñoz
- Servei de Pneumologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - Mónica González
- Unidad de Sueño y Ventilación, Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de investigación Marqués de Valdecilla, IDIVAL, Santander, Cantabria, España
| | - Sarah Béatrice Heili-Frades
- Neumología, Unidad de Cuidados Respiratorios Intermedios, Hospital Universitario Fundación Jiménez, Madrid; Díaz Quirón Salud. IIS. CIBERES, REVA Network, EMDOS, España
| | - María Ángeles Sánchez Quiroga
- Servicio de Neumología, Hospital Virgen del Puerto de Plasencia, Plasencia, Cáceres; CIBER de Enfermedades Respiratorias (CIBERES), ISCIII, Madrid; Instituto Universitario de Investigación Biosanitaria en Extremadura (INUBE), Cáceres, España
| | - Gemma Rialp Cervera
- Servicio de Medicina Intensiva, Hospital Universitari Son Llàtzer, Palma de Mallorca; Grupo de Trabajo de SEMICUYC de Insuficiencia Respiratoria Aguda, España
| | - Gonzalo Hernández
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, España
| | | | - Rafael Uña
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - Carlos Ferrando Ortolà
- Sección Área de Cuidados Intensivos Quirúrgicos, Servicio de Anestesia y Cuidados Intensivos, Hospital Clínic, Barcelona, España
| | - Miquel Ferrer Monreal
- Servei de Pneumologia, Institut del Tòrax, Hospital Clínic de Barcelona, IDIBAPS, CibeRes (CB06/06/0028), Universitat de Barcelona, Barcelona, España
| | - Carlos Egea Santaolalla
- Unidad Funcional de Sueño, Hospital Universitario Araba, OSI Araba, Vitoria-Gasteiz, Araba, España
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10
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Luján M, Peñuelas Ó, Cinesi Gómez C, García-Salido A, Moreno Hernando J, Romero Berrocal A, Gutiérrez Ibarluzea I, Masa Jiménez JF, Mas A, Carratalá Perales JM, Gaboli M, Concheiro Guisán A, García Fernández J, Escámez J, Parrilla Parrilla J, Farrero Muñoz E, González M, Heili-Frades SB, Sánchez Quiroga MÁ, Rialp Cervera G, Hernández G, Sánchez Torres A, Uña R, Ortolà CF, Ferrer Monreal M, Egea Santaolalla C. Summary of recommendations and key points of the consensus of Spanish scientific societies (SEPAR, SEMICYUC, SEMES; SECIP, SENEO, SEDAR, SENP) on the use of non-invasive ventilation and high-flow oxygen therapy with nasal cannulas in adult, pediatric, and neonatal patients with severe acute respiratory failure. Med Intensiva 2020; 45:298-312. [PMID: 33309463 DOI: 10.1016/j.medin.2020.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/25/2020] [Indexed: 11/28/2022]
Abstract
Non-invasive respiratory support (NIRS) in adult, pediatric, and neonatal patients with acute respiratory failure (ARF) comprises two treatment modalities, non-invasive mechanical ventilation (NIMV) and high-flow nasal cannula (HFNC) therapy. However, experts from different specialties disagree on the benefit of these techniques in different clinical settings. The objective of this consensus was to develop a series of good clinical practice recommendations for the application of non-invasive support in patients with ARF, endorsed by all scientific societies involved in the management of adult and pediatric/neonatal patients with ARF. To this end, the different societies involved were contacted, and they in turn appointed a group of 26 professionals with sufficient experience in the use of these techniques. Three face-to-face meetings were held to agree on recommendations (up to a total of 71) based on a literature review and the latest evidence associated with 3 categories: indications, monitoring and follow-up of NIRS. Finally, the experts from each scientific society involved voted telematically on each of the recommendations. To classify the degree of agreement, an analogue classification system was chosen that was easy and intuitive to use and that clearly stated whether the each NIRS intervention should be applied, could be applied, or should not be applied.
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Affiliation(s)
- M Luján
- Servicio de Neumología, Hospital Universitari Parc Taulí de Sabadell, Sabadell, Barcelona; Universitat Autònoma de Barcelona, Barcelona; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - Ó Peñuelas
- Servicio de Medicina Intensiva y Grandes Quemados, Hospital Universitario de Getafe, Getafe, Madrid; CIBER de Enfermedades Respiratorias (CIBERES), Madrid; Grupo de Trabajo de la SEMICYUC de Insuficiencia Respiratoria Aguda, España.
| | - C Cinesi Gómez
- Servicio de Urgencias, Hospital General Universitario Reina Sofía. Director del Máster en Medicina de Urgencias y Emergencias de la Universidad Católica de Murcia (UCAM), Murcia, España
| | - A García-Salido
- Servicio de Cuidados Intensivos Pediátricos e Investigador Posdoctoral en el Laboratorio de Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - J Moreno Hernando
- Servicio de Neonatología, Hospital Universitari Sant Joan de Déu, Barcelona, España
| | - A Romero Berrocal
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | - I Gutiérrez Ibarluzea
- Fundación vasca de Innovación e Investigación Sanitarias, Barakaldo, Vizcaya, España
| | - J F Masa Jiménez
- Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Instituto Universitario de Investigación Biosanitaria deExtremadura (INUBE), Cáceres, España
| | - A Mas
- Servei de Medicina Intensiva, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona; Hospital General d'Hospitalet, L'Hospitalet de Llobregat, Barcelona; Grupo deTrabajo de la SEMICYUC de Insuficiencia Respiratoria Aguda, España
| | - J M Carratalá Perales
- Servicio de Urgencias, Unidad de Corta Estancia, Hospital General Universitario, Alicante, España
| | - M Gaboli
- Neumología Pediátrica y Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A Concheiro Guisán
- Unidad de Neonatología, Hospital Alvaro Cunqueiro, Vigo, Pontevedra, España
| | - J García Fernández
- Servicio de Anestesia, Cuidados Críticos Quirúrgicos y Dolor, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | - J Escámez
- Servicio de Urgencias, Hospital Virgen de los Lirios, Alcoy, Alicante, España
| | - J Parrilla Parrilla
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - E Farrero Muñoz
- Servei de Pneumologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Madrid, España
| | - M González
- Unidad de Sueño y Ventilación, Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de investigación Marqués de Valdecilla, IDIVAL, Santander, Cantabria, España
| | - S B Heili-Frades
- Neumología, Unidad de Cuidados Respiratorios Intermedios, Hospital Universitario Fundación Jiménez, Madrid; Díaz Quirón Salud. IIS. CIBERES, REVA Network, EMDOS, España
| | - M Á Sánchez Quiroga
- Servicio de Neumología, Hospital Virgen del Puerto de Plasencia, Plasencia, Cáceres; CIBER de Enfermedades Respiratorias (CIBERES), ISCIII, Madrid; Instituto Universitario de Investigación Biosanitaria en Extremadura (INUBE), Cáceres, España
| | - G Rialp Cervera
- Servicio de Medicina Intensiva, Hospital Universitari Son Llàtzer, Palma de Mallorca; Grupo de Trabajo de SEMICYUC de Insuficiencia Respiratoria Aguda, España
| | - G Hernández
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo; Grupo de Trabajo de la SEMICYUC de Insuficiencia Respiratoria Aguda, España
| | - A Sánchez Torres
- Servicio de Neonatología, Hospital Universitario La Paz, Madrid, España
| | - R Uña
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - C F Ortolà
- Sección Área de Cuidados Intensivos Quirúrgicos, Servicio de Anestesia y Cuidados Intensivos, Hospital Clínic, Madrid, España
| | - M Ferrer Monreal
- Servei de Pneumologia, Institut del Tòrax, Hospital Clínic de Barcelona, IDIBAPS, CibeRes (CB06/06/0028), Universitat de Barcelona, Madrid, España
| | - C Egea Santaolalla
- Unidad Funcional de Sueño, Hospital Universitario Araba, OSI Araba, Vitoria-Gasteiz, Araba, España
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11
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Sahni AS, Tran LK, Wolfe LF. Extubating to Noninvasive Ventilation: Noninvasive Ventilation from Intensive Care Unit to Home. Sleep Med Clin 2020; 15:581-592. [PMID: 33131667 DOI: 10.1016/j.jsmc.2020.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Weaning to noninvasive ventilation in intensive care unit and bridging the patients to home with respiratory support is evolving as the technology of noninvasive ventilation is improving. In patients with chronic obstructive pulmonary disease exacerbation, timing of initiation of noninvasive ventilation is the key, as persistently hypercapnic patients show benefits. High-intensity pressure support seems to do better in comparison to low-intensity pressure support. In patients with obesity and hypercapnia, obesity hypoventilation cannot be ruled out especially in an inpatient setting, and it is crucial that these patients are discharged with noninvasive ventilation.
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Affiliation(s)
- Ashima S Sahni
- Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, 909 S Wolcott Ave, Room 3135 (MC 719), Chicago, IL 60612, USA.
| | - Lien-Khuong Tran
- Pulmonary, Critical Care and Sleep, Texas Pulmonary & Critical Care Consultants, 1201 Fairmount Avenue, Fort Worth, TX 76104, USA
| | - Lisa F Wolfe
- Department of Pulmonary and Critical Care, Northwestern University, 675 North Saint Clair Street, 14 th floor Pulmonary Medicine, Chicago, Illinois 60611, USA
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12
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Dual Carbon Dioxide Capture to Achieve Highly Efficient Ultra-Low Blood Flow Extracorporeal Carbon Dioxide Removal. Ann Biomed Eng 2020; 48:1562-1572. [PMID: 32072384 DOI: 10.1007/s10439-020-02477-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 02/08/2020] [Indexed: 10/25/2022]
Abstract
Extracorporeal CO2 removal is a highly promising support therapy for patients with hypercapnic respiratory failure but whose clinical implementation and patient benefit is hampered by high cost and highly specialized expertise required for safe use. Current approaches target removal of the gaseous CO2 dissolved in blood which limits their ease of clinical use as high blood flow rates are required to achieve physiologically significant CO2 clearance. Here, a novel hybrid approach in which a zero-bicarbonate dialysis is used to target removal of bicarbonate ion coupled to a gas exchange device to clear dissolved CO2, achieves highly efficiently total CO2 capture while maintaining systemic acid-base balance. In a porcine model of acute hypercapnic respiratory failure, a CO2-reduction of 61.4 ± 14.4 mL/min was achieved at a blood flow rate of 248 mL/min using pediatric-scale priming volumes. The dialyzer accounted for 81% of total CO2 capture with an efficiency of 33% with a minimal pH change across the entire circuit. This study demonstrates the feasibility of a novel hybrid CO2 capture approach capable of achieving physiologically significant CO2 removal at ultralow blood flow rates with low priming volumes while leveraging widely available dialysis platforms to enable clinical adoption.
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13
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Scala R, Pisani L. Noninvasive ventilation in acute respiratory failure: which recipe for success? Eur Respir Rev 2018; 27:27/149/180029. [DOI: 10.1183/16000617.0029-2018] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/16/2018] [Indexed: 12/12/2022] Open
Abstract
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” (i.e.patient selection, interface, ventilator, interface,etc.) and to avoid a delayed intubation if the ventilation attempt fails.
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14
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Scala R, Heunks L. Highlights in acute respiratory failure. Eur Respir Rev 2018; 27:27/147/180008. [PMID: 29592866 PMCID: PMC9489047 DOI: 10.1183/16000617.0008-2018] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 03/05/2018] [Indexed: 11/22/2022] Open
Abstract
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. 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 futurehttp://ow.ly/xbPi30iUP2y
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Affiliation(s)
- Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy
| | - Leo Heunks
- Dept of Intensive Care, VU University Medical Centre, Amsterdam, The Netherlands
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15
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Polastri M, Paganelli F, Campanello S, Pelagalli V. Cooperation between nursing staff and physiotherapists is crucial in pneumonology units. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.3.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Massimiliano Polastri
- Physiotherapist, Medical Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, University Hospital St Orsola-Malpighi, Bologna, Italy
| | - Francesca Paganelli
- Nurse, Department of Cardiac-Thoracic and Vascular Diseases, Unit of Pneumonology, University Hospital St Orsola-Malpighi, Bologna, Italy
| | - Salvatore Campanello
- Nurse, Department of Cardiac-Thoracic and Vascular Diseases, Unit of Pneumonology, University Hospital St Orsola-Malpighi, Bologna, Italy
| | - Virginia Pelagalli
- Head nurse, Department of Cardiac-Thoracic and Vascular Diseases, Unit of Pneumonology, University Hospital St Orsola-Malpighi, Bologna, Italy
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16
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Cortegiani A, Russotto V, Antonelli M, Azoulay E, Carlucci A, Conti G, Demoule A, Ferrer M, Hill NS, Jaber S, Navalesi P, Pelosi P, Scala R, Gregoretti C. Ten important articles on noninvasive ventilation in critically ill patients and insights for the future: A report of expert opinions. BMC Anesthesiol 2017; 17:122. [PMID: 28870157 PMCID: PMC5584318 DOI: 10.1186/s12871-017-0409-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 08/23/2017] [Indexed: 12/15/2022] Open
Abstract
Background Noninvasive 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. Methods We 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. Results The 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. Conclusions The 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 material The online version of this article (10.1186/s12871-017-0409-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Cortegiani
- Department of Biopathology and Medical Biotechnologies (DIBIMED). Section of Anestesia, Analgesia, Intensive Care and Emergency, Policlinico P. Giaccone, University of Palermo, Palermo, Italy.
| | - V Russotto
- Department of Biopathology and Medical Biotechnologies (DIBIMED). Section of Anestesia, Analgesia, Intensive Care and Emergency, Policlinico P. Giaccone, University of Palermo, Palermo, Italy
| | - M Antonelli
- Department of Intensive Care and Anaesthesia, Policlinico A. Gemelli, Catholic University of Rome, Rome, Italy
| | - E Azoulay
- Réanimation médicale, Hôpital Saint Louis, APHP, Paris, France
| | - A Carlucci
- Pulmonary Rehabilitation Unit, IRCCS Fondazione S. Maugeri, Pavia, Italy
| | - G Conti
- Department of Intensive Care and Anaesthesia, Policlinico A. Gemelli, Catholic University of Rome, Rome, Italy
| | - A Demoule
- UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Sorbonne Universités, UPMC Univ Paris 06, INSERM, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), 75013, Paris, France
| | - M Ferrer
- Department of Pneumology, Respiratory Institute, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, CibeRes (CB06/06/0028), University of Barcelona, Barcelona, Spain
| | - N S Hill
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MA, USA
| | - S Jaber
- Department of Anesthesiology and Critical Care Medicine B (DAR B), Saint-Eloi Hospital, University Teaching Hospital of Montpellier, Montpellier, France
| | - P Navalesi
- Anesthesia and Intensive Care, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - P Pelosi
- IRCCS AOU San Martino-IST, Department of Surgical Sciences and Integrated Diagnostics (DISC), IRCCS AOU San Martino IST, University of Genoa, Genoa, Italy
| | - R Scala
- Pulmonology and RICU, S. Donato Hospital, Arezzo, Italy
| | - C Gregoretti
- Department of Biopathology and Medical Biotechnologies (DIBIMED). Section of Anestesia, Analgesia, Intensive Care and Emergency, Policlinico P. Giaccone, University of Palermo, Palermo, Italy
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17
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Seiler F, Trudzinski FC, Kredel M, Lotz C, Lepper PM, Muellenbach RM. [Update: acute hypercapnic respiratory failure]. Med Klin Intensivmed Notfmed 2017; 114:234-239. [PMID: 28707030 DOI: 10.1007/s00063-017-0318-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/17/2017] [Accepted: 06/04/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Hypercapnic respiratory failure is a frequent problem in critical care and mainly affects patients with acute exacerbation of COPD (AECOPD) and acute respiratory distress syndrome (ARDS). In recent years, the usage of extracorporeal CO2 removal (ECCO2R) has been increasing. OBJECTIVE Summarizing the state of the art in the management of hypercapnic respiratory failure with special regard to the role of ECCO2R. METHODS Review based on a selective literature search and the clinical and scientific experience of the authors. RESULTS Noninvasive ventilation (NIV) is the therapy of choice in hypercapnic respiratory failure due to AECOPD, enabling stabilization in the majority of cases and generally improving prognosis. Patients in whom NIV fails have an increased mortality. In these patients, ECCO2R may be sufficient to avoid intubation or to shorten time on invasive ventilation; however, corresponding evidence is sparse or even missing when it comes to hard endpoints. Lung-protective ventilation according to the ARDS network is the standard therapy of ARDS. In severe ARDS, low tidal volume ventilation may result in critical hypercapnia. ECCO2R facilitates compensation of respiratory acidosis even under "ultra-protective" ventilator settings. Yet, no positive prognostic effects could be demonstrated so far. CONCLUSION Optimized use of NIV and lung-protective ventilation remains standard of care in the management of hypercapnic respiratory failure. Currently, ECCO2R has to be considered an experimental approach, which should only be provided by experienced centers or in the context of clinical trials.
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Affiliation(s)
- F Seiler
- Klinik für Innere Medizin V - Pneumologie, Allergologie, Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, 66421, Homburg/Saar, Deutschland. .,ECLS Center Saar, 66421, Homburg, Deutschland.
| | - F C Trudzinski
- Klinik für Innere Medizin V - Pneumologie, Allergologie, Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, 66421, Homburg/Saar, Deutschland.,ECLS Center Saar, 66421, Homburg, Deutschland
| | - M Kredel
- Universitätsklinikum Würzburg, Klinik und Poliklinik für Anästhesiologie, 97080, Würzburg, Deutschland
| | - C Lotz
- Universitätsklinikum Würzburg, Klinik und Poliklinik für Anästhesiologie, 97080, Würzburg, Deutschland
| | - P M Lepper
- Klinik für Innere Medizin V - Pneumologie, Allergologie, Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, 66421, Homburg/Saar, Deutschland.,ECLS Center Saar, 66421, Homburg, Deutschland
| | - R M Muellenbach
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum Kassel GmbH, 34125, Kassel, Deutschland
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18
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Roca O, Hernández G, Díaz-Lobato S, Carratalá JM, Gutiérrez RM, Masclans JR. Current evidence for the effectiveness of heated and humidified high flow nasal cannula supportive therapy in adult patients with respiratory failure. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:109. [PMID: 27121707 PMCID: PMC4848798 DOI: 10.1186/s13054-016-1263-z] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
High flow nasal cannula (HFNC) supportive therapy has emerged as a safe, useful therapy in patients with respiratory failure, improving oxygenation and comfort. Recently several clinical trials have analyzed the effectiveness of HFNC therapy in different clinical situations and have reported promising results. Here we review the current knowledge about HFNC therapy, from its mechanisms of action to its effects on outcomes in different clinical situations.
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Affiliation(s)
- Oriol Roca
- Critical Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain. .,Ciber Enfermedades Respiratorias (Ciberes), Instituto de Salud Carlos III, Madrid, Spain.
| | - Gonzalo Hernández
- Critical Care Department, Virgen de la Salud Hospital, Toledo, Spain
| | - Salvador Díaz-Lobato
- Respiratory Medicine Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - José M Carratalá
- Emergency Medicine Department, Alicante General Hospital, Alicante, Spain
| | - Rosa M Gutiérrez
- Anesthesiology Department, De Cruces General Hospital, Bilbao, Spain
| | - Joan R Masclans
- Ciber Enfermedades Respiratorias (Ciberes), Instituto de Salud Carlos III, Madrid, Spain.,Critical Care Department, Del Mar University Hospital, IMIM (Medical Research del Mar Hospital Institute), Barcelona, Spain
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