Respiratory Failure In Emergency Department Research Articles

Comparison of high flow and standard oxygen therapy in patients with acute hypoxemic respiratory failure in emergency department. A randomized controlled cross over superiority trial

Comparison of high flow and standard oxygen therapy in patients with acute hypoxemic respiratory failure in emergency department. A randomized controlled cross over superiority trial

Non-invasive ventilation strategy for patients with acute respiratory failure in emergency department – a systematic review

Background: We sought to assess the efficacy of noninvasive positive pressure ventilation against high-flow nasal cannula in patients experiencing acute respiratory failure, as they may be necessary if the respiratory insufficiency is more severe. Method: We conducted a thorough search from 2013 to 2023 throughout EMBASE, Cochrane library, MEDLINE, and CINAHL database. We incorporated randomized control trials that contrasted adult patients with ARF with HFNC and NIPPV. We collected data on trial features, demographics, intervention and control arm management, and clinical outcome outcomes of interest. For the economic outcomes, we collected data on the analytical approach, research design, time horizon, study viewpoint, and study features. Results: We included 6 RCTs with a total of 1421 patients after evaluating 612 citations. Patients in RCTs ranged in number from 30 to 791. Of the six RCTs, one was published after being abstracted. Overall, HFNC was compared to facemask NIPPV in five investigations, and to both facemasks in one research. Patients with hypoxic respiratory failure caused by the corona virus were included in two investigations, along with those with mixed hypoxia respiratory failure, immunocompromised patients by themselves, and one study with mixed respiratory failure. Conclusion: While there is conflicting evidence about the impact of HFNC and NIPPV on mortality in hospitalized patients with hypoxemic respiratory failure, they may be equally successful in lowering the requirement for intubation.

Risk factors for non-invasive ventilation failure in influenza infection with acute respiratory failure in emergency department.

Non-invasive ventilation (NIV) has been widely used in hypoxemic acute respiratory failure (ARF) due to influenza pneumonia in the emergency department (ED). However, NIV used in influenza-associated acute respiratory failure had a variable rate of failure. Previous studies have reported that prolonged use of NIV was associated with increased mortality. Our study aimed to identify risk factors for NIV failure in influenza infection with acute respiratory failure in ED. We performed a retrospective cohort observational study. Enrolled patients were older than 18years who used NIV due to influenza infection with ARF between 1 January 2017 to 31 December 2018 in Ramathibodi Emergency Department. Patients characteristics, comorbidity, clinical, laboratory outcome, chest imaging, initial NIV setting, and parameters were collected in ED setting. Sequential organ failure assessment (SOFA) score and PaO2/FiO2 (PF) ratio were calculated from the first arterial blood gas in ED. We followed the outcome success or failure of the NIV used. A total of 162 patients were enrolled and 72 (44%) suffered NIV failure in influenza infection with ARF. We used univariate and multivariate logistic analyses to assess risk factors for NIV failure. The ability of risk factor to predict NIV failure was analyzed using the area under the receiver operating characteristic (AUROC). Risk factors of NIV failure included SOFA score (P=0.001), PF ratio (P=0.001) and quadrant infiltrations in chest x-rays (CXR) (P=0.001). SOFA score, PF ratio, and number quadrant infiltrations in chest radiography have good ability to predict NIV failure, AUROC 0.894 (95%CI 0.839-0.948), 0.828 (95%CI 0.764-0.892), and 0.792 (95%CI 0.721-0.863), respectively and no significant difference in the ability to predict NIV failure among three parameters. The use of PF ratio plus number quadrant infiltrations in chest radiography demonstrated a higher predictive ability for NIV failure in influenza infection with ARF. SOFA score, PF ratio, and quadrant infiltrations in chest radiography were good predictors of NIV failure in influenza infection with ARF.

Noninvasive Positive Pressure Ventilation for Acute Respiratory Failure in Emergency Department: a Qualitative Review

The roles of noninvasive positive pressure ventilation (NIPPV) as a treatment modality for patients presenting with acute respiratory failure (ARF) to the emergency department (ED) have not been clearly identified. The major advantages of NIPPV are avoiding patient's discomforts and complications relating to endotracheal intubation and mechanical ventilation. This review is to explore the current evidence on the effectiveness of NIPPV in various subgroups of patients with ARF. The rationales, advantages, complications and contraindications in the usage of NIPPV will also be discussed. There is robust evidence to support the use of NIPPV in severe acute exacerbation of chronic obstructive airway disease (COAD). A modest amount of favourable evidence supports the use of Continuous Positive Airway Pressure (CPAP) in cardiogenic pulmonary oedema, although the potential for harm has not been excluded. There exists no solid evidence supporting the use of NIPPV in asthma and pneumonia. Early institution of NIPPV in the ED is appropriate, feasible, likely to be beneficial and without major complications. Further good quality studies to evaluate the roles of NIPPV for ARF in the ED setting are needed to define which groups of patients can gain most benefit from this type of treatment.