Abstract | PURPOSE OF REVIEW: RECENT FINDINGS: Maintenance of spontaneous breathing by means of noninvasive respiratory support in hypoxemic patients with vigorous spontaneous effort carries the risk of patient self-induced lung injury: the benefit of averting intubation in successful patients should be balanced with the harms of a worse outcome in patients who are intubated after failing a trial of noninvasive support.The risk of noninvasive treatment failure is greater in patients with the most severe oxygenation impairment (PaO2/FiO2 < 200 mmHg).High-flow nasal oxygen (HFNO) is the most widely applied intervention in COVID-19 patients with hypoxemic respiratory failure. Also, noninvasive ventilation (NIV) and continuous positive airway pressure delivered with different interfaces have been used with variable success rates. A single randomized trial showed lower need for intubation in patients receiving helmet NIV with specific settings, compared to HFNO alone.Prone positioning is recommended for moderate-to-severe acute respiratory distress syndrome patients on invasive ventilation. Awake prone position has been frequently applied in COVID-19 patients: one randomized trial showed improved oxygenation and lower intubation rate in patients receiving 6-h sessions of awake prone positioning, as compared to conventional management. SUMMARY: Noninvasive respiratory support and awake prone position are tools possibly capable of averting endotracheal intubation in COVID-19 patients; carefully monitoring during any treatment is warranted to avoid delays in endotracheal intubation, especially in patients with PaO2/FiO2 < 200 mmHg.
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Authors | Luca S Menga, Cecilia Berardi, Ersilia Ruggiero, Domenico Luca Grieco, Massimo Antonelli |
Journal | Current opinion in critical care
(Curr Opin Crit Care)
Vol. 28
Issue 1
Pg. 25-50
(02 01 2022)
ISSN: 1531-7072 [Electronic] United States |
PMID | 34694240
(Publication Type: Journal Article, Review)
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Copyright | Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved. |
Topics |
- COVID-19
- Humans
- Noninvasive Ventilation
- Pandemics
- Respiratory Distress Syndrome
(therapy)
- Respiratory Insufficiency
(etiology, therapy)
- SARS-CoV-2
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