Dose-response characteristics of noninvasive ventilation in acute respiratory failure

The right interface for the right patient in noninvasive ventilation: a systematic review

INTRODUCTION

Research in the field of noninvasive ventilation (NIV) has contributed to the development of new NIV interfaces. However, interface tolerance plays a crucial role in determining the beneficial effects of NIV therapy.

AREAS COVERED

This systematic review explores the most significant scientific research on NIV interfaces, with a focus on the potential impact that their design might have on treatment adherence and clinical outcomes. The rationale on the choice of the right interface among the wide variety of devices that are currently available is discussed here.

EXPERT OPINION

The paradigm "The right mask for the right patient" seems to be difficult to achieve in real life. Ranging from acute to chronic settings, the gold standard should include the tailoring of NIV interfaces to patients' needs and preferences. However, such customization may be hampered by issues of economic nature. High production costs and the increasing demand represent consistent burdens and have to be considered when dealing with patient-tailored NIV interfaces. New research focusing on developing advanced and tailored NIV masks should be prioritized; indeed, interfaces should be designed according to the specific patient and clinical setting where they need to be used.

Noninvasive ventilation usage time and survival rate in patients with acute respiratory failure: some key insights

One of the major causes of emergency admissions is acute respiratory failure (ARF) [1]. Noninvasive ventilation (NIV) is increasingly used for ARF management because of its efficacy (particularly in hypercapnic patients), achievable goals and because it can be outside the intensive care unit [2]. The benefits of NIV are still under investigation in various hypoxaemic respiratory failure (HRF) aetiologies, such as asthma, pneumonia, immunosuppression and acute respiratory distress syndrome [1].

The possibility of avoiding adverse events by recommending early determination of mask-on proportions in the first 24 h of admission and, consequently, NIV failure in ARF patientshttps://bit.ly/2T0QYVN

Noninvasive ventilation usage time and survival rate in patients with acute respiratory failure: some key insights

We would like to thank Y.M. Madney and colleagues for their considered comments. The data in our recent study are predominantly related to the hypercapnic group reflecting the demand for noninvasive ventilation (NIV) [1]. We agree that the hypercapnic and hypoxaemic respiratory failure (HRF) cohorts were not matched, which is not unexpected when considering that the pathogensis of these two entities are very different. We have previously demonstrated that there are poorer outcomes with hypoxaemic than hypercapnic respiratory failure in a respiratory high dependency unit [2], and there is an increasing proportion of patients with HRF managed in high dependency units. We believe that our recent study indicates that the two entities have different dose–response relationships for NIV but agree that a larger HRF cohort is required to determine the dose characteristics of this group.

Dose–response characteristics of noinvasive ventilation differ between hypoxaemic and hypercapnic respiratory failurehttps://bit.ly/2SYitiC