Respiratory failure oxygen therapy and endotracheal intubation: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
No edit summary |
||
| Line 6: | Line 6: | ||
==Oxygen therapy== | ==Oxygen therapy== | ||
*The aim of oxygen therapy is to correct hypoxia | *The aim of oxygen therapy is to correct hypoxia.<ref name="pmid28860265">{{cite journal |vauthors=Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S, Navalesi P, Antonelli M, Brozek J, Conti G, Ferrer M, Guntupalli K, Jaber S, Keenan S, Mancebo J, Mehta S, Raoof S |title=Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure |journal=Eur. Respir. J. |volume=50 |issue=2 |pages= |date=August 2017 |pmid=28860265 |pmc=5593345 |doi=10.1183/13993003.02426-2016 |url=}}</ref> | ||
*These therapies may include: | *These therapies may include: | ||
**Non-invasive ventilatory support | **Non-invasive ventilatory support | ||
| Line 13: | Line 13: | ||
===Non-invasive ventilatory support (NIV)=== | ===Non-invasive ventilatory support (NIV)=== | ||
*Non-invasive ventilatory support (NIV) uses positive pressure ventilation delivered through a face or nasal mask or nasal prongs as a non-invasive way of delivering oxygen. | *Non-invasive ventilatory support (NIV) uses positive pressure ventilation delivered through a face or nasal mask or nasal prongs as a non-invasive way of delivering oxygen. | ||
*Non-invasive ventilatory support (NIV) is indicated for: | *Non-invasive ventilatory support (NIV) is indicated for:<ref name="pmid11208659">{{cite journal |vauthors= |title=International Consensus Conferences in Intensive Care Medicine: noninvasive positive pressure ventilation in acute Respiratory failure |journal=Am. J. Respir. Crit. Care Med. |volume=163 |issue=1 |pages=283–91 |date=January 2001 |pmid=11208659 |doi=10.1164/ajrccm.163.1.ats1000 |url=}}</ref><ref name="pmid12907562">{{cite journal |vauthors=Liesching T, Kwok H, Hill NS |title=Acute applications of noninvasive positive pressure ventilation |journal=Chest |volume=124 |issue=2 |pages=699–713 |date=August 2003 |pmid=12907562 |doi= |url=}}</ref><ref name="pmid7697242">{{cite journal |vauthors=Ferguson GT, Gilmartin M |title=CO2 rebreathing during BiPAP ventilatory assistance |journal=Am. J. Respir. Crit. Care Med. |volume=151 |issue=4 |pages=1126–35 |date=April 1995 |pmid=7697242 |doi=10.1164/ajrccm.151.4.7697242 |url=}}</ref><ref name="pmid7697242">{{cite journal |vauthors=Ferguson GT, Gilmartin M |title=CO2 rebreathing during BiPAP ventilatory assistance |journal=Am. J. Respir. Crit. Care Med. |volume=151 |issue=4 |pages=1126–35 |date=April 1995 |pmid=7697242 |doi=10.1164/ajrccm.151.4.7697242 |url=}}</ref><ref name="pmid8045145">{{cite journal |vauthors=Soo Hoo GW, Santiago S, Williams AJ |title=Nasal mechanical ventilation for hypercapnic respiratory failure in chronic obstructive pulmonary disease: determinants of success and failure |journal=Crit. Care Med. |volume=22 |issue=8 |pages=1253–61 |date=August 1994 |pmid=8045145 |doi= |url=}}</ref> | ||
**Acute hypoxemic respiratory failure | **Acute hypoxemic respiratory failure | ||
**Chronic obstructive pulmonary disease (COPD) complicated by hypercapnic acidosis | **Chronic obstructive pulmonary disease (COPD) complicated by hypercapnic acidosis | ||
| Line 28: | Line 28: | ||
====Mask selection==== | ====Mask selection==== | ||
*Studies have demonstrated that a face mask confers the largest physiological improvement, whilst nasal masks and prongs are tolerated the best. | *Studies have demonstrated that a face mask confers the largest physiological improvement, whilst nasal masks and prongs are tolerated the best.<ref name="pmid12907562">{{cite journal |vauthors=Liesching T, Kwok H, Hill NS |title=Acute applications of noninvasive positive pressure ventilation |journal=Chest |volume=124 |issue=2 |pages=699–713 |date=August 2003 |pmid=12907562 |doi= |url=}}</ref><ref name="pmid17194316">{{cite journal |vauthors=Holland AE, Denehy L, Buchan CA, Wilson JW |title=Efficacy of a heated passover humidifier during noninvasive ventilation: a bench study |journal=Respir Care |volume=52 |issue=1 |pages=38–44 |date=January 2007 |pmid=17194316 |doi= |url=}}</ref><ref name="pmid8045145">{{cite journal |vauthors=Soo Hoo GW, Santiago S, Williams AJ |title=Nasal mechanical ventilation for hypercapnic respiratory failure in chronic obstructive pulmonary disease: determinants of success and failure |journal=Crit. Care Med. |volume=22 |issue=8 |pages=1253–61 |date=August 1994 |pmid=8045145 |doi= |url=}}</ref><ref name="pmid10713013">{{cite journal |vauthors=Antón A, Güell R, Gómez J, Serrano J, Castellano A, Carrasco JL, Sanchis J |title=Predicting the result of noninvasive ventilation in severe acute exacerbations of patients with chronic airflow limitation |journal=Chest |volume=117 |issue=3 |pages=828–33 |date=March 2000 |pmid=10713013 |doi= |url=}}</ref> | ||
*Face masks are preferred in several studies and have the following advantages: | *Face masks are preferred in several studies and have the following advantages: | ||
**Less air leaks compared to volumes lost with nasal masks through the oral cavity | **Less air leaks compared to volumes lost with nasal masks through the oral cavity | ||
| Line 38: | Line 38: | ||
====Monitoring NIV==== | ====Monitoring NIV==== | ||
*Success or failure of NIV therapy is established within an initial observation period of 8 hours. | *Success or failure of NIV therapy is established within an initial observation period of 8 hours.<ref name="pmid17019559">{{cite journal |vauthors=Demoule A, Girou E, Richard JC, Taille S, Brochard L |title=Benefits and risks of success or failure of noninvasive ventilation |journal=Intensive Care Med |volume=32 |issue=11 |pages=1756–65 |date=November 2006 |pmid=17019559 |doi=10.1007/s00134-006-0324-1 |url=}}</ref> | ||
**During this time adjustments should be made, whilst looking for signs of destabilization. | **During this time adjustments should be made, whilst looking for signs of destabilization. | ||
*An improvement in arterial carbon dioxide tension (PaCO2) and pH within 1.5 - 2 hours is indicative of successful NIV. | *An improvement in arterial carbon dioxide tension (PaCO2) and pH within 1.5 - 2 hours is indicative of successful NIV. | ||
| Line 56: | Line 56: | ||
====Advantages of NIV==== | ====Advantages of NIV==== | ||
*NIV has lower mortality rates (23%) in comparison to traditional mechanical ventilation (39%). | *NIV has lower mortality rates (23%) in comparison to traditional mechanical ventilation (39%).<ref name="pmid9407237">{{cite journal |vauthors=Guérin C, Girard R, Chemorin C, De Varax R, Fournier G |title=Facial mask noninvasive mechanical ventilation reduces the incidence of nosocomial pneumonia. A prospective epidemiological survey from a single ICU |journal=Intensive Care Med |volume=23 |issue=10 |pages=1024–32 |date=October 1997 |pmid=9407237 |doi= |url=}}</ref><ref name="pmid15972113">{{cite journal |vauthors=Hess DR |title=Noninvasive positive-pressure ventilation and ventilator-associated pneumonia |journal=Respir Care |volume=50 |issue=7 |pages=924–9; discussion 929–31 |date=July 2005 |pmid=15972113 |doi= |url=}}</ref> | ||
*NIV therapy carries less risk of nosocomial infection transmission such as ventilator - associated pneumonias, sinusitis and line sepsis. | *NIV therapy carries less risk of nosocomial infection transmission such as ventilator - associated pneumonias, sinusitis and line sepsis. | ||
*NIV facilitates a decreased need for invasive mechanical ventilation. | *NIV facilitates a decreased need for invasive mechanical ventilation. | ||
Revision as of 19:03, 9 March 2018
|
Respiratory failure Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Respiratory failure oxygen therapy and endotracheal intubation On the Web |
|
American Roentgen Ray Society Images of Respiratory failure oxygen therapy and endotracheal intubation |
|
FDA on Respiratory failure oxygen therapy and endotracheal intubation |
|
CDC on Respiratory failure oxygen therapy and endotracheal intubation |
|
Respiratory failure oxygen therapy and endotracheal intubation in the news |
|
Blogs on Respiratory failure oxygen therapy and endotracheal intubation |
|
Risk calculators and risk factors for Respiratory failure oxygen therapy and endotracheal intubation |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
Oxygen therapy
- The aim of oxygen therapy is to correct hypoxia.[1]
- These therapies may include:
- Non-invasive ventilatory support
- Extracorporeal membrane oxygenation
Non-invasive ventilatory support (NIV)
- Non-invasive ventilatory support (NIV) uses positive pressure ventilation delivered through a face or nasal mask or nasal prongs as a non-invasive way of delivering oxygen.
- Non-invasive ventilatory support (NIV) is indicated for:[2][3][4][4][5]
- Acute hypoxemic respiratory failure
- Chronic obstructive pulmonary disease (COPD) complicated by hypercapnic acidosis
- Use of (NIV) is contraindicated in cases of need of emergent intubation, such as:
- Myocardial arrest
- Respiratory arrest
- Inability to preserve a patent airways
- Severely altered consciousness
- Life threatening organ failiure of nonpulmonary origin
- Abnormalities of facial structure for any reason
- High risk of aspiration
- Expected long term treatment with mechanical ventilation
- Recent esophageal surgery with anastomoses
Mask selection
- Studies have demonstrated that a face mask confers the largest physiological improvement, whilst nasal masks and prongs are tolerated the best.[3][6][5][7]
- Face masks are preferred in several studies and have the following advantages:
- Less air leaks compared to volumes lost with nasal masks through the oral cavity
- Nasal masks increase resistance to air flow and therefore, increase respiratory effort
- Face masks make it easier to assess aspiration risk in comparison to a nasal mask
Ventilatory modes
Will be discussed in the mechanical ventilation section of this chapter.
Monitoring NIV
- Success or failure of NIV therapy is established within an initial observation period of 8 hours.[8]
- During this time adjustments should be made, whilst looking for signs of destabilization.
- An improvement in arterial carbon dioxide tension (PaCO2) and pH within 1.5 - 2 hours is indicative of successful NIV.
- Indications of failed NIV include:
- A lack of improvement in arterial carbon dioxide tension (PaCO2) and pH within 1.5 - 2 hours
- Encephalopathy
- Agitation
- Unclearable secretions
- Intolerable mask interface
- Decreased oxygen saturation
- Hemodynamic instability
- Successful selection of patients with indications for NIV by physicians is poor and therefore, a third of patients that receive a trial of NIV fail.
- The use of sedatives and analgesics, for purposes of comfort and anxiety is not recommended as studies have demonstrated an increase in NIV failure rates with pretreatment of these agents.
Weaning
- Weaning is carried out through progressively decreasing positive pressure settings, whilst permitting the patient longer durations without ventilation.
Advantages of NIV
- NIV has lower mortality rates (23%) in comparison to traditional mechanical ventilation (39%).[9][10]
- NIV therapy carries less risk of nosocomial infection transmission such as ventilator - associated pneumonias, sinusitis and line sepsis.
- NIV facilitates a decreased need for invasive mechanical ventilation.
References
- ↑ Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S, Navalesi P, Antonelli M, Brozek J, Conti G, Ferrer M, Guntupalli K, Jaber S, Keenan S, Mancebo J, Mehta S, Raoof S (August 2017). "Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure". Eur. Respir. J. 50 (2). doi:10.1183/13993003.02426-2016. PMC 5593345. PMID 28860265.
- ↑ "International Consensus Conferences in Intensive Care Medicine: noninvasive positive pressure ventilation in acute Respiratory failure". Am. J. Respir. Crit. Care Med. 163 (1): 283–91. January 2001. doi:10.1164/ajrccm.163.1.ats1000. PMID 11208659.
- ↑ 3.0 3.1 Liesching T, Kwok H, Hill NS (August 2003). "Acute applications of noninvasive positive pressure ventilation". Chest. 124 (2): 699–713. PMID 12907562.
- ↑ 4.0 4.1 Ferguson GT, Gilmartin M (April 1995). "CO2 rebreathing during BiPAP ventilatory assistance". Am. J. Respir. Crit. Care Med. 151 (4): 1126–35. doi:10.1164/ajrccm.151.4.7697242. PMID 7697242.
- ↑ 5.0 5.1 Soo Hoo GW, Santiago S, Williams AJ (August 1994). "Nasal mechanical ventilation for hypercapnic respiratory failure in chronic obstructive pulmonary disease: determinants of success and failure". Crit. Care Med. 22 (8): 1253–61. PMID 8045145.
- ↑ Holland AE, Denehy L, Buchan CA, Wilson JW (January 2007). "Efficacy of a heated passover humidifier during noninvasive ventilation: a bench study". Respir Care. 52 (1): 38–44. PMID 17194316.
- ↑ Antón A, Güell R, Gómez J, Serrano J, Castellano A, Carrasco JL, Sanchis J (March 2000). "Predicting the result of noninvasive ventilation in severe acute exacerbations of patients with chronic airflow limitation". Chest. 117 (3): 828–33. PMID 10713013.
- ↑ Demoule A, Girou E, Richard JC, Taille S, Brochard L (November 2006). "Benefits and risks of success or failure of noninvasive ventilation". Intensive Care Med. 32 (11): 1756–65. doi:10.1007/s00134-006-0324-1. PMID 17019559.
- ↑ Guérin C, Girard R, Chemorin C, De Varax R, Fournier G (October 1997). "Facial mask noninvasive mechanical ventilation reduces the incidence of nosocomial pneumonia. A prospective epidemiological survey from a single ICU". Intensive Care Med. 23 (10): 1024–32. PMID 9407237.
- ↑ Hess DR (July 2005). "Noninvasive positive-pressure ventilation and ventilator-associated pneumonia". Respir Care. 50 (7): 924–9, discussion 929–31. PMID 15972113.