Respiratory failure oxygen therapy and endotracheal intubation

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Oxygen therapy

• The aim of oxygen therapy is to correct hypoxia
• 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:
  • 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.
• 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