Noninvasive Oxygenation in Patients with Acute Respiratory Failure: Current Perspectives

Figures & data

Table 1 Aims of Noninvasive Oxygen Supports in Acute Respiratory Failure

Expected Effect of Noninvasive Oxygen Support According to the Type of Acute Respiratory Failure
Acute hypoxemic respiratory failure	To avoid intubation and to decrease related mortality	Acute hypercapnic respiratory failure
To preserve tolerance	Comfort	To preserve tolerance
↗ PaO2, PaO2/FiO2	Blood gas improvement	↘ PaCO2
↘ Inspiratory effort	To unload inspiratory muscles	↘ Inspiratory effort
To ensure prevention of lung injury		↘ Expiratory flow limitation

Figure 1 Physiological responses of high-flow nasal oxygen therapy and noninvasive ventilation to acute hypoxemic respiratory failure.

Notes: Adapted with permission of the American Thoracic Society. Copyright © 2022 American Thoracic Society. All rights reserved. Brochard L, Slutsky A, Pesenti A. Mechanical ventilation to minimize progression of lung injury in acute respiratory failure. Am J Respir Crit Care Med. 2017;195(4):438–442. The American Journal of Respiratory and Critical Care Medicine is an official journal of the American Thoracic Society. Readers are encouraged to read the entire article for the correct context at (https://www.atsjournals.org/doi/10.1164/rccm.201605-1081CP). The authors, editors, and The American Thoracic Society are not responsible for errors or omissions in adaptations.¹⁹

Table 2 Summary of Proposals for First-Line Therapies in Acute Respiratory Failure

	Standard Oxygen	Noninvasive Ventilation with Face Mask	Noninvasive Ventilation with Helmet	High-Flow Nasal Cannula Oxygen Therapy	Comment
Acute hypoxemic respiratory failure	+	-	-	+	One RCT has reported benefits of HFNC versus NIV and standard oxygen.
Immunocompromised patients	+	+	No trial	+	NIV is recommended by the recent European/American guidelines. However, studies are ongoing to determine the place of HFNC.
COPD exacerbation with acute respiratory acidosis		+++	?	-	NIV is strongly recommended by the recent European/American guidelines. HFNC can be an alternative in case of intolerance to NIV.
Non-severe COPD exacerbation	+	Not recommended	?	+	HFNC seems to be superior over standard oxygen.

Abbreviations: COPD, chronic obstructive pulmonary disease; HFNT, high-flow nasal cannula oxygen therapy; NIV, noninvasive ventilation; RCT, randomized controlled trial.

Brochard L, Slutsky A, Pesenti A. Mechanical ventilation to minimize progression of lung injury in acute respiratory failure. Am J Respir Crit Care Med. 2017;195(4):438–442. doi:10.1164/rccm.201605-1081CP

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