Method Of Respiratory Support Research Articles

High-flow nasal oxygen in infants and children for early respiratory management of pneumonia-induced acute hypoxemic respiratory failure: the CENTURI randomized clinical trial

ObjectiveTo compare the effectiveness of early high-flow nasal cannula (HFNC) and low-flow oxygen support (LFOS) in children under 5 years with acute hypoxemic respiratory failure (AHRF) due to severe community-acquired pneumonia in low-middle-income countries.MethodsAn open-label randomized clinical trial enrolled children aged 2–59 months with AHRF due to severe community-acquired pneumonia and randomized into HFNC and LFOS. In the LFOS group, the patient received cold wall oxygen humidified by bubbling through sterile water administered through simple nasal prongs at a fixed flow rate of 2 L/min. In the HFNC group, the patient received humidified, heated (37 °C), high-flow oxygen at a flow rate assigned based on weight range, with a titratable oxygen fraction. The primary outcome was treatment failure in 72 h (escalating the respiratory support method using any modality other than primary intervention).ResultsData was analyzed intention-to-treat (HFNC = 124; LFOS = 120). Median (IQR) age was 12 (6–20) and 11 (6–27) months, respectively. Treatment failure occurred in a significantly lower proportion in the HFNC group (7.3%, n = 9/124) as compared to the LFOS group (20%, n = 24/120) (relative risk = 0.36, 95% CI 0.18 to 0.75; p = 0.004; adjusted hazard ratio 0.34, 95% CI 0.16 to 0.73; p = 0.006). The intubation rate was significantly lower in the HFNC group (7.3%, n = 9/124 vs. 16.7%, n = 20/120; relative risk = 0.44, 95% CI 0.21 to 0.92, p = 0.023). There were no significant differences noted in other secondary outcomes. No mortality occurred.ConclusionHigh-flow nasal cannula oxygen therapy used as early respiratory support in children under 5 years with acute hypoxemic respiratory failure due to severe community-acquired pneumonia was associated with significantly lower treatment failure compared with standard low-flow oxygen support.Trial registration CTRI/2016/04/006788. Registered 01 April 2016, https://ctri.nic.in/Clinicaltrials/advsearch.php.

Cerebral oxymetry in patients with ischemic stroke and concomitant obstructive sleep apnea syndrome

Cerebral stroke is an important medical and social problem of our time and the most common cause of permanent disability. In patients with brain damage due to ischemic stroke and concomitant obstructive sleep apnoea, numerous episodes of hypoventilation and apnoea cause significant «failures» in saturation and changes in cerebral perfusion, which negatively affects immediate and long-term treatment outcomes. Cerebral oximetry is widely used in clinical practice in various fields of surgery (cardiovascular, paediatric, neurosurgery, etc.), but its potential as a method of monitoring secondary brain damage and controlling treatment in patients with ischaemic cerebral stroke is poorly understood. Objective — to evaluate the effect of non-invasive CPAP support (Continuous Positive Airway Pressure — a method of non-invasive respiratory support in which positive pressure is created in the patient’s airways) on cerebral oximetry in the treatment of patients with ischaemic stroke and concomitant obstructive sleep apnoea syndrome. Materials and methods. Patients with verified mild to moderate ischaemic stroke underwent screening diagnostics to confirm the presence of obstructive sleep apnoea syndrome (SomnoChek micro, Weinman, Germany). We studied 60 patients with obstructive sleep apnoea in the setting of ischemic stroke, who were divided into two groups depending on the treatment method: control (n = 30), in which only conventional stroke treatment was used, and experimental (n = 30), in which the traditional treatment regimen and respiratory support (auto-SAPP) during night sleep with the ResMed Air Sencei apparatus (Australia) were used. To monitor the effectiveness of respiratory support, along with other methods of objective control, cerebral oximetry was used using the Masimo Root apparatus (Masimo, USA). The average rSO2 values on the side of the stroke-affected hemisphere were recorded at the following times: at the beginning of the study, on the 3rd, 5th and 7th day of treatment. The data obtained were processed statistically. Results. The initial average values of rSO2 of the affected by stroke hemisphere in patients of groups I and II were in the range of pathological values, and were (49.27 ± 4.98) and (50.60 ± 5.40) %, respectively, that is, the groups at the beginning of the study were compared to each other. It was found, that in group I patients statistically significant changes in rSO2 % in the intervals of the 1st and 3rd days, the 3rd and 5th days, and the 5th and 7th days — were not observed. Only during the 7th day of observation we’ve recorded statistically significant rSO2 growth at 15.6 % compared to the initial values up to the mark of (57.03 ± 7.01) %. Instead, the rSO2 changes in patients of group II (who were performed СРАР-support at night against the traditional treatment of a stroke), were dynamic and statistically probable: a controlled index during the 3rd day of observation has increased at 12.2 %, during the 5th day — at 26.5 %, during the 7th day — at 33.6 % compared to the initial values up to the level of (67.64 ± 3.02) % compared to the initial values. Conclusions. Standardized medicinal therapy and early rehabilitation of patients with ischemic stroke does not affect the course and severity of concomitant obstructive sleep apnea syndrome and requires a supplement with the methods of non-invasive respiratory support during night sleep. Patients with ischemic stroke against the background of autoCPAP-therapy, were recorded positive dynamics in terms of correction of obstructive sleep apnea syndrome and stable normalization of cerebral oxymetry.

Intraoperative Use of High-Flow Nasal Cannula in Elderly Patients Undergoing Hip Fracture Repair Under Spinal Anesthesia: A Randomized Controlled Study.

The procedure of hip fracture repair poses a risk for postoperative pulmonary complications (PPCs) in elderly patients, accompanied by anesthesia and operations. Various noninvasive methods of respiratory support are used as prophylactic and therapeutic, mainly in the postoperative period. Objective: This study aims to determine whether intraoperative use of a high-flow nasal cannula (HFNC) impacts elderly patient outcomes after hip fracture surgery. Seventy patients aged 65 and older undergoing traumatic hip surgery under spinal anesthesia for isolated hip fractures were randomly assigned to either an interventional group (I) utilizing a high-flow nasal cannula or a control group (C) without respiratory intervention in a six-month single-blind controlled study at Sahloul Teaching Hospital. The two groups had identical socio-demographic traits and baseline data. Respiratory postoperative complications occurred in two patients in group (I) and in nine patients in group (C), with a significant difference (p = 0.023). The main respiratory postoperative complications in group (I) were atelectasis (one case) and pulmonary edema (one case). The main respiratory postoperative complications in group (C) were atelectasis (four cases), pneumonia (two cases), COPD decompensation (two cases), and pulmonary edema (one case). No intensive care unit admissions or intraoperative complications were associated with using HFNC. The mean length of stay (LOS) in the hospital was 8.83 ± 2.91 for group I and 10.46 ± 3.4 for group (C), which differed significantly (p = 0.03) with no in-hospital mortality for the two groups. The intraoperative administration of HFNC may lower the incidence of postoperative respiratory complications and the duration of hospital stays.

Characteristics of anesthetic and surgical tactics in treatment of a patient with a giant thyroid mass in a cancer center (clinical case)

This paper describes an example of radical surgical treatment of a patient with a giant retrosternal goiter complicated by compression of the organs of the neck and mediastinum. Considering all the risks and possible complications, we should take into account the fact that enlarged thyroid (T) body with retrosternal location can cause displacement and stenosis of the trachea and esophagus, and dislocation of large vessels and nerves of the mediastinum. This anatomical specificity is an imminent threat to successful treatment, and it also carries a certain risk of asphyxia and sudden death of the patient. In this clinical case, radical surgical treatment in this patient included sequential mobilization in two pleural cavities, and then the total removal of T through the traditional surgical access. The anesthetic complexity to support the surgical intervention involved both difficult intubation due to tracheal stenosis, and also the required separate ventilation of the lungs to visualize anatomical structures and mobilize a multinodular formation in two pleural cavities. Standard methods of artificial lung ventilation could be ineffective and even dangerous in this case due to the location and size of the tumor. We focused our attention on high-frequency ventilation (HFV), the best method of respiratory support during surgeries for tracheal and bronchial pathologies. The main task of the anesthetic team in this clinical case was to prevent the development of hypercapnia and hypoxia during intubation of the stenotic tracheal segment, and then adequate ventilation of the lungs with reduced area of proper gas exchange due to bilateral surgical pneumothorax. Thus, the full treatment was carried out due to the only safe method of compensating lung ventilation with anesthesia by HFV. The applied HFV method creates an adequate gas exchange in the lungs due to the small ventilation volume and high frequency of respiratory cycles per minute. HFV both prevented the development of threatening complications during intubation of the stenotic tracheal area and ensured an adequate gas exchange during successive thoracoscopic stages of thyroid tumor mobilization.

Venovenous Extracorporeal Membrane Oxygenation in Severe Polytrauma

BACKGROUND. Road transport injuries (RTI) are the leading cause of death among the working-age population at present. Often, severe combined trauma is accompanied by significant damage to the chest with the development of severe respiratory disorders. Standard methods of intensive therapy for respiratory failure are often ineffective. The use of extracorporeal membrane oxygenation (ECMO) can be an effective method of reducing mortality in this category of patients, evenin conditions where it is impossible to use systemic anticoagulation. AIM OF THE STUDY. Consider the use of ECMO in patients with serious polytrauma trauma and a high risk of hemorrhagic complications. MATERIAL AND METHODS. Patient R., 43 years old, got a severe combined injury in a traffic accident; due to progressive acute respiratory failure, veno-venous ECMO (VV-ECMO) was performed for 11 days. RESULTS. This report reviews a clinical observation of the successful use of VV-ECMO in a patient with severe acute respiratory distress syndrome as a result of polytrauma in a road accident. Due to the high risk of hemorrhagic complications, the procedure was performed without the use of systemic anticoagulation, which is a rather rare case in modern intensive care. On the 11th day, the VV-ECMO procedure was stopped. On the 7th day of VV-ECMO, an intense hemorrhagic syndrome developed as a complication, which was successfully treated. On the 13th day after weaning, the patient was transferred from the intensive care unit to the rehabilitation center. CONCLUSIONS. The venovenous extracorporeal membrane oxygenation method can be considered as part of the treatment of severe acute respiratory distress syndrome as a result of severe chest trauma when standard methods of respiratory support are ineffective. With a high risk of hemorrhagic complications, which is often observed in patients in this category, it is possible to use venovenous extracorporeal membrane oxygenation without systemic anticoagulation.

The demographic profile, clinical spectrum, and outcome of term neonates requiring continuous positive airway pressure in a tertiary care teaching hospital

Background: Respiratory distress is the major cause of neonatal intensive care unit (NICU) admission of full-term neonates for which they require different levels of mode of ventilation. Aims and Objectives: The objective of this study was to determine the demographic profile, clinical spectrum, and outcome of term neonates, requiring continuous positive airway pressure (CPAP) in tertiary care teaching hospitals. Materials and Methods: The study was a prospective observational study conducted from December 2020 to November 2022 in the neonatal section of the department of pediatrics. Results: A total of 261 neonates were included in the study. The male-to-female ratio was 1.7:1, the range of birth weight was between 2.1 kg and 3 kg (60.91%), the gestation age was 38 weeks (59.2%), and 73.6% were lower-segment cesarean section born. The age of starting CPAP in most of the newborns was at admission to NICU (in 69.73% of cases). The success rate of CPAP therapy was high (60.9%) and the rest 39.08% of patients did not settle with CPAP and required higher modes of respiratory support such as nasalintermittent positive pressure ventilation (IPPV) (5.89%) and IPPV (94.11%). Conclusion: In the resource-limiting settings, due to the non-availability of higher levels of ventilatory gadgets, the early use of CPAP as a mode of ventilation in full-term babies with transient tachypnea of newborns is well-documented and it can be safely used in other common neonatal conditions which can cause respiratory distress in full-term neonates. The low-middle-income countries are facing challenges to improve comprehensive neonatal care; there is a dire need for simple and cost-effective methods of respiratory support. Bubble CPAP is one such promising ventilatory support intervention, which may reduce the need for costly mechanical ventilators.

To study the efficiency of high-flow nasal cannula in improving the arterial blood gas parameters in children admitted to pediatric intensive care unit with respiratory distress

Abstract Background: In recent times, heated humidified high-flow nasal cannula has become increasingly popular and is now recognized as a standard respiratory support method for pediatric patients experiencing acute respiratory distress. Aims and Objectives: To study the correlation of high-flow nasal cannula (HFNC) with arterial blood gas (ABG) and clinical parameters. Materials and Methods: This prospective observational study included children aged 1 month to 14 years experiencing acute respiratory distress receiving HFNC support. Demographic information, vital signs, and ABG parameters were collected at four-time points: the first ABG at “0” h, indicating admission; the second ABG at “1” h, approximately 1 h after HFNC initiation; the third ABG at “12” h, as a follow-up after the initiation of respiratory support; and the fourth ABG at “24” h, representing daily monitoring for assessing the child’s condition and outcomes. The collected data was subjected to analysis. Results: The study included 133 children, of which 64.66% were male and 35.34% were female, with a mean age of 0.9 years (ranging from 0.3 to 3 years) and a mean weight of 7.8 kg (ranging from 4.7 to 11.8 kg). Over time, there was a statistically significant decrease in heart rate, respiratory rate, and the need for FiO2. Significant reductions in these parameters were observed within the first hour of initiating HFNC therapy, and improvements continued at 12 and 24 h compared to the baseline values (P value < 0.05). The study also revealed a decreasing trend in pCO2 and lactate levels over time. Statistically significant reductions in these parameters were noted at the first hour of HFNC initiation, and improvements persisted at 12 and 24 h compared to the baseline (P value < 0.05). On the other hand, there was an increasing trend in SpO2, pO2, base excess, and HCO3 over time. Significant increases in these parameters were observed at the first hour of HFNC initiation, and the positive trend continued at 12 and 24 h compared to the baseline (P value < 0.05). Conclusion: HFNC can serve as the primary noninvasive respiratory support for children facing respiratory distress. The majority of patients in our study demonstrated good tolerance to the HFNC. Notably, the utilization of HFNC resulted in a significant enhancement of the comfort scale among the participants. Positive changes were observed in vital parameters, comfort scale, and ABG parameters within just 1 h of initiating HFNC.

Possibility of using non-invasive modes of respiratory support at the stages of interhospital transportation of newborns

Introduction. Respiratory support remains the most common procedure performed by neonatal transport team specialists. Non-invasive ventilation is a very common method of respiratory support for newborns, reducing the incidence of chronic lung disease. However, the safety and efficacy of this type of support during transportation remain controversial. The aim of the work is to determine the current state of the problem of non-invasive respiratory support in newborns in the initial medical organization, at the stage of pre-transport preparation and during transportation. Materials and methods. Literature sources were searched and selected in PubMed and eLibrary. The following queries were used for the search: nasal continuous positive airway pressure, non invasive ventilation, neonate, newborn, patient transportation, transport, transfer. Types of studies considered: retrospective observational studies, prospective studies (randomized, quasi-randomized, non-randomized), systematic reviews, meta-analyses, clinical protocols. Depth of search − 20 years. The total number of publications included in the review was 61, including 29 studies directly related to the use of noninvasive ventilation in interhospital neonatal transport. Results and discussion. Non-invasive respiratory support is one of the priority and actively used methods of therapy of respiratory disorders of various genesis in neonatology. Nasal CPAP is used both independently and in conjunction with various methods of surfactant administration, reducing the risk of a combined outcome “death or chronic lung disease”. It is recommended both as a method of starting respiratory support and as an intermediate option to increase the probability of successful extubation. There is limited experience with non-invasive respiratory support during interhospital transport of neonates. The available studies suggest that when patients are selected rationally and reasonable criteria are applied to administer nCPAP en route, this method of respiratory support is safe, effective, maintains the benefits of spontaneous breathing, and reduces the duration of intensive care. The small number and poor design quality of studies in this direction do not allow at this stage to form evidence-based recommendations. Conclusion. Medical evacuation of newborns from 1−2 level institutions to level 3 organization with nCPAP is safe and has a number of potential benefits. Existing recommendations are empirical, and there are exceptionally few studies evaluating the validity of such recommendations.

Ultrasound Assessment of Gastric Volume in Parturients After High-flow Nasal Oxygen Therapy

(Anesth Analg. 2023;137:176–181) High-flow nasal oxygen (HFNO) therapy is a preferred method of respiratory support for pregnant women but concerns have been raised for gastric complications because of the positive airway pressure. Pregnancy causes physiological changes that can increase the risk of oxygen insufflation into the stomach, as well as the risk of aspiration. Aspiration risk can be determined by ultrasound assessment of gastric volume and antral cross-sectional area (CSA). This study was designed to assess the safety of HFNO therapy by examining changes in antral CSA and gastric volume via ultrasonography before and after HFNO administration, with a hypothesis that 20 minutes of HFNO therapy would increase gastric volume by 50%.

Evaluation of Respiratory Support Methods and Characteristics of Pneumothorax in Late Preterm and Term Newborns within the First 48 hours of Life

AbstractThis study aims to evaluate risk factors, respiratory support procedures, and characteristics of pneumothorax in late preterm and term newborns diagnosed with pneumothorax within the first 48 hours of life. The study included late preterm and term newborns diagnosed with pneumothorax within the first 48 hours of life. The neonates diagnosed with pneumothorax within the first 24 hours of life (Group 1) and those diagnosed between 24 and 48 hours (Group 2) were analyzed in terms of risk factors, respiratory support procedures, and characteristics of pneumothorax. Twenty newborns, 11 in Group 1 and 9 in Group 2, with a mean gestational age of 37.9 ± 1.2 weeks and birth weight of 3,133 ± 464 g, were included the study. The resuscitation rate in the delivery room was insignificantly higher in Group 1. There was no significant difference between the two groups in terms of respiratory support methods (mechanical ventilation [MV], noninvasive ventilation, oxygen) on admission and at the time of diagnosis. The rate of receiving MV during treatment was significantly higher in Group 2 (p = 0.014). Although duration of MV and chest drainage were significantly shorter in Group 1 (p = 0.026 and p = 0.026, respectively), when we considered only survivors (all three deceased newborns died within the first day of life), these durations were still shorter; however, the difference was no longer significant. Pneumothorax should be suspected in late preterm and term newborns with respiratory distress within the first 2 days of life, especially in the presence of risk factors.

Comparison of the different oxygen delivery and ventilatory support methods for treating patients with COVID-19 induced type 1 hypoxemic respiratory failure

Having claimed the lives of over five million people in the span of two years, SARS-COV-2 caused a global health crisis and a debate between clinicians on the best respiratory interventions to use in fighting this disease. This paper aims to evaluate the different methods of respiratory support at a clinician’s disposal when treating COVID-19 induced type 1 hypoxemic respiratory failure. Data was acquired by running a literature search on MEDLINE and Web of Science using terms such as “COVID-19”, “Mortality”, “CPAP”, “Outcomes”. From 355 papers found, 11 are included in this paper. Studies have shown both CPAP and HFNO are effective when treating mild hypoxemia in COVID-19 patients, however if they fail, then chances of patient survival are slim, even if a patient’s treatment is escalated. The literature has shown that mechanical ventilation has a slightly higher survival rate than both CPAP and HFNO when used as a primary treatment and patients who are escalated to mechanical ventilation have a slim chance of survival. Considering the findings, it is crucial that clinicians consider factors such as a patient’s initial PaO2/FiO2 as well as age when deciding on whether a patient should be ventilated or treated with CPAP or HFNO.

ЭФФЕКТИВНОСТЬ КРАТКОСРОЧНОЙ РАР-ТЕРАПИИ У БОЛЬНЫХ ФИБРОЗИРУЮЩИМИ ИНТЕРСТИЦИАЛЬНЫМИ ЗАБОЛЕВАНИЯМИ ЛЕГКИХ

The results of the use of non-invasive lung ventilation (NIV) with the creation of positive airway pres-sure (Positive Airway Pressure) or PAP-therapy in patients with fibrosing interstitial lung diseases (FILD) are presented. The assessment of the initial functional status and the dynamics of changes was carried out using a cardiopulmonary exercising test (CPET). Objective: to evaluate the effectiveness of PAP-therapy, as one of the methods of respiratory support, in patients with FILD using CPET. Materi-als and Methods: The study included 35 patients with clinically-radiologically or histologically veri-fied FILD, among them, 60% were idiopathic pulmonary fibrosis, 31 % – exogenous fibrosing-type allergic alveolitis, 9 % – pleuroparenchymal fibroelastosis. All patients underwent CPET at baseline, after which they were randomized into 2 groups: the main group A – 18 people who received PAP-therapy for 1 month and the control group B – 17 people who did not receive respiratory therapy. A month later, all patients repeated CPET in dynamics. Results of the study: after 1 month of PAP-therapy in patients of the study, the main group A, there was a statistically significant change in some indicators of CPET, such as an improvement in the ventilation-perfusion ratio, in the form of a de-crease in the VD/VT (p = 0,09), an increase efficiency of the work performed (decrease in VO2/WR(p=0,02)), increase in the power of the work performed (MET (p=0,02), wt/kg (p=0,03)). In patients of the control group B after 1 month no statistically significant changes in CPET indicators were found. Comparative analysis between groups also confirmed more efficient oxygen delivery in group A. Conclusion: we can assume a positive effect of a short-term course of NIV respiratory sup-port on the functional status of the respiratory system in FILD patients, in particular, an improvement in the ventilation-perfusion balance at rest and during exercise, as well as an increase in exercise toler-ance.

Proposed protocol for utilising high-flow nasal oxygen therapy in treatment of dogs hospitalised due to pneumonia

BackgroundHigh-flow nasal oxygen (HFNO) therapy is a non-invasive respiratory support method that provides oxygen-enriched, warmed, and humidified air to respiratory-compromised patients. It is widely used in human medical care, but in veterinary medicine it is still a relatively new method. No practical guidelines exist for its use in canine pneumonia patients, although they could potentially benefit from HFNO therapy. This study aims to provide a new, safe, non-invasive, and effective treatment protocol for oxygen supplementation of non-sedated dogs with pneumonia.MethodsTwenty privately owned dogs with pneumonia will receive HFNO therapy at a flow rate of 1–2 L/kg, and the fraction of inspired oxygen will be determined individually (ranging from 21% to 100%). HFNO therapy will continue as long as oxygen support is needed based on clinical evaluation. Patients will be assessed thrice daily during their hospitalisation, with measured primary outcomes including partial pressure of oxygen, oxygen saturation, respiratory rate and type, days in hospital, and survival to discharge.DiscussionThe proposed protocol aims to provide a practical guideline for applying HFNO to dogs hospitalised due to pneumonia. The protocol could enable more efficient and well-tolerated oxygenation than traditional methods, thus hastening recovery and improving survival of pneumonia patients.

Management of respiratory failure in immune checkpoint inhibitors-induced overlap syndrome: a case series and review of the literature

BackgroundCheckpoint inhibitor-induced overlap syndrome ([OS] myocarditis, and myositis with or without myasthenia gravis) is rare but life-threatening.Cases presentationHere we present a case series of four cancer patients that developed OS. High troponinemia raised the concern for myocarditis in all the cases. However, the predominant clinical feature differed among the cases. Two patients showed marked myocarditis with a shorter hospital stay. The other two patients had a prolonged ICU stay due to severe neuromuscular involvement secondary to myositis and myasthenia gravis. Treatment was based on steroids, plasmapheresis, intravenous immunoglobulin, and immunosuppressive biological agents.ConclusionThe management of respiratory failure is challenging, particularly in those patients with predominant MG. Along with intensive clinical monitoring, bedside respiratory mechanics can guide the decision-making process of selecting a respiratory support method, the timing of elective intubation and extubation.

Current approaches to respiratory pathology in late preterm infants

Late preterm babies are those born between 340/7 and 366/7 weeks of gestation, constituting the largest subgroup of preterm infants. Despite the relative morphofunctional maturity, these children remain at a high risk of damage to various organs and systems, and there is also a high mortality rate. One of the top places in the structure of morbidity in late preterm is occupied by respiratory disorders. Quite often there is transient tachypnea, respiratory distress syndrome of the newborn, pulmonary hypertension, and congenital pneumonia. Currently, there are various approaches to prevention, treatment, and diagnosis of respiratory disorders in late preterm children. Until now, the issue of the advisability of prenatal prevention of respiratory distress syndrome with corticosteroids after the 34th week of gestation has not been resolved. Non-invasive methods of respiratory support are more popular along with minimally invasive administration of surfactant preparations when indicated. The trend towards an annual increase in late preterm births determines the need to improve the methods of their nursing. The control over respiratory disorders and hypoxia is crucial in the prevention of adverse outcomes in late preterm children.

Evaluation of Alveolo-arterial Oxygen Gradient and Mortality in Different Respiratory Support Methods in Severe COVID-19 Patients Followed in the Intensive Care Unit

Evaluation of Alveolo-arterial Oxygen Gradient and Mortality in Different Respiratory Support Methods in Severe COVID-19 Patients Followed in the Intensive Care Unit

The use of non-invasive respiratory assistance to facilitate bronchofiberoscopy performance in patients with hypoxemic (type one) respiratory failure - Study protocol

PurposeBronchofiberoscopy (FOB) is a procedure routinely performed for: lung cancer, obstruction, interstitial diseases, foreign bodies’ removal, airway clearance, and hemoptysis. It causes acute airway narrowing leading to respiratory and cardiovascular stress. Due to increasing number of ill patients with respiratory failure (RF), conventional oxygen therapy (COT) is frequently insufficient to assure accurate oxygenation and prevent RF in patients requiring FOB. In this clinical scenario, patients may be intubated and supported with invasive mechanical ventilation (IMV) with the specific aim of allowing a safe FOB. However, this invasive strategy is associated with an increased risk of IMV-associated complications. Materials and methodsOur study is a planned prospective multicenter three-arm randomized controlled trial (RCT). The target number of 300 patients was calculated based on the intubation risk in RF patients, which is 0.2–2%. The patients will be assigned to each arm based on Horowitz index. In each arm, the patients will be randomly assigned to one out of two dedicated respiratory support methods in each group i.e. COT/high flow nasal cannula (HFNC), HFNC/non-invasive ventilation (NIV) and NIV/IMV. In the manuscript the current state of art in the area of respiratory support is discussed. We have underlined knowledge gaps in medical evidence which we are planning to reveal with our results. ResultsThe results of our study are clinically crucial, because they address current gaps concerning COT/HFNC/NIV/IMV. ConclusionThe expected findings of this study would allow for careful selection of respiratory support method to safely perform FOB in patients with hypoxemic RF.

Role of high flow nasal therapy in Intensive Care Units

Introduction and purpose: High Flow Nasal Therapy is quite new respiratory support method, although recently it became more popular – especially during COVID-19 pandemic. Physiological mechanisms as well as main applications were observed and described in several randomized controlled trias and metaanalisys. The purpose of this review is to present fundamental studies and indicate applications of this method.
 Brief description of the state of knowladge: Breathing mixture with a maximum flow 60l/min needs to be heated and humidified to protect the airways from dryness. Optimal humidity improves mucocilary clearance, reduces inflammation of the airways and energy expenditure, especially in acute respiratory failure. High flow nasal therapy may imrpove the mechanics of breathing also by washout of nasopharyngeal dead space and generating positive airway pressure during exhalation, which keeps airways open and prevents the alveoli from collapsing. High flow therapy can be use in many different applications but at Intensive Care Unit the most important are: acute hypoxemia, during extubation or rest breaks from NIV. It is important to monitor the patient and predict the need for intubation on time. There are physiological states that we shoud focus on: respiratory rate, dyspnea or work of breathing, but it is good to know ROX index which can be helpful to assess the success of the therapy.
 Summary (conlcusions): High flow nasal therapy is a simple and safety respiratory support method that can be applicable at Intensive Care Units. It can lower the intubation numbers and help during NIV rest breaks. High flow nasal therapy is a very promising method for all patients with respiratory failure but it is important to monitor the patient and not delay the intubation.

High flow nasal cannula for respiratory support in term infants.

High flow nasal cannula for respiratory support in term infants.

Comparison of noninvasive respiratory support methods in the postoperative period in cardiac surgery patients: a prospective randomized trial

INTRODUCTION: The frequency of respiratory failure in the postoperative period is 17–22 % [1–3]. The most commonly used methods: noninvasive positive pressure mask ventilation (NIPPMV), high-flow nasal cannula (HFNС), noninvasive positive pressure helmet ventilation (NIPPHV). OBJECTIVE: Comparison of the effectiveness of respiratory support methods depending on their effect on gas exchange in patients with mild to moderate respiratory failure in the early period after cardiac surgery. MATERIALS AND METHODS: The study included 42 cardiac surgery patients with 200 < P/F < 300 who were divided into 3 groups depending on the methods of respiratory support used (NIPPMV, HFNС, NIPPHV). The main point of the study is to assess the dynamics of the gas exchange indicators before, during and after their use. RESULTS: All three methods of NIVL contribute to a statistically significant improvement in gas exchange during NIVL, which persisted after the end of therapy (SpO2, PaO2, P/F, Qsp/Qt). In the group with the use of NIPPMV and HFNС an increase in the oxyhemoglobin fraction. In the course of this study, no data were revealed on changes in PaCO2. The largest increase in SpO2 was revealed in groups using a mask and helmet, but at the end of the NIVL session there were no statistically significant differences between the groups. A decrease in the proportion of patients with P/F < 300 after a single session in the NIPPMV group by 2 times, in the HFNC group — by 1.6 times, in the NIPPHV group — by 3.5 times. CONCLUSIONS: Conducting noninvasive respiratory support significantly improves the indicators of oxygenating lung function in the early postoperative period in cardiac surgery patients. NIPPHV and NIPPMV are more effective compared to HFNC. When using a helmet, a higher level of support is required.