Special issue of Journal of Intensive Medicine analyzes non-invasive respiratory support

Acute hypoxemic respiratory failure (AHRF) represents one of the most common yet challenging conditions treated in intensive care units (ICUs) worldwide. While the emergence of multiple options for non-invasive respiratory support has revolutionized care in such cases, selecting the optimal approach remains difficult. Now, a special issue from the Journal of Intensive Medicine titled “Non-invasive respiratory support for acute hypoxemic respiratory failure” provides key insights to guide these critical treatment decisions.

This collection establishes a robust foundation for understanding the key respiratory support challenges encountered in the ICU, offering evidence-based guidance for clinicians worldwide. “Acute hypoxemic respiratory failure is one of the most frequent reasons for ICU admission, and selecting the right non-invasive respiratory support strategy can significantly impact patient outcomes, including oxygenation, comfort, and most importantly, the risk of intubation and mortality,” explains Professor Arnaud W. Thille from the University of Poitiers, France, who serves as guest editor for this issue.

The special issue features a diverse range of articles exploring various facets of non-invasive respiratory support. The main editorial provides an overarching perspective on the current evidence supporting different non-invasive strategies in AHRF. It reviews the efficacy of high-flow nasal cannula oxygen (HFNC), continuous positive airway pressure (CPAP), and noninvasive ventilation (NIV), highlighting the nuances of their application and outcomes in light of recent trials and experiences from the COVID-19 pandemic. In general, HFNC appears to be superior to standard oxygen in avoiding intubation in moderate-to-severe cases of hypoxemia, while the role of CPAP and NIV as first-line alternatives requires careful consideration when HFNC is not available.

Building on this, two review articles engage in a compelling debate on whether high-flow nasal oxygen should be seen as the reference treatment in AHRF. One article argues that despite widespread adoption, HFNC does not fully meet the criteria of a reference treatment due to inconsistencies in study results, concerns about potential delayed intubation, patient self-inflicted lung injury, and limited accessibility in resource-constrained settings. Conversely, the other article strongly advocates HFNC, citing its proven ability to reduce intubation risk compared to standard oxygen and its superior tolerance over NIV and CPAP, making it a recommended first-line option.

Another review titled “Noninvasive ventilation in acute hypoxemic respiratory failure: What is the future?” delves into the challenges and opportunities for NIV. It explores the reasons for current conflicting data on NIV’s efficacy, emphasizing the need for improved early predictive criteria for failure, a re-evaluation of NIV settings to avoid insufficient support, and further exploration of interface choices. The authors also highlight the potential for NIV in resource-limited settings given its inexpensive nature.

A fourth review titled “Diagnostic approach in acute hypoxemic respiratory failure” highlights the importance of rapid and accurate identification of the underlying cause of AHRF. Given that a significant percentage of AHRF cases lack clear classic risk factors, especially in immunocompromised patients, the article stresses the need for multidisciplinary and comprehensive diagnostic work-up.

Finally, “Awake prone positioning and ventilation distribution as assessed by electric impedance tomography in patients with non-COVID-19 acute hypoxemic respiratory failure: A prospective physiology study” presents novel insights into the physiological mechanisms of awake prone positioning (APP). Using electrical impedance tomography, the authors demonstrate that APP can improve distribution and homogeneity of lung ventilation in non-intubated patients with AHRF. This offers a deeper understanding of how this simple intervention can aid in preventing intubation.

Overall, the contents of this special issue serve as a timely and valuable resource for clinicians and researchers dedicated to critical care. It provides a nuanced understanding of non-invasive respiratory support, addressing current debates, future directions, and practical diagnostic approaches to improve outcomes for patients with AHRF.

 

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Reference

URL: https://www.sciencedirect.com/special-issue/10D6XP4JXPC

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