New Clinical Practice Guidelines, September 2017

John Anello; Brian Feinberg; Richard Lindsey; Cristina Wojdylo; Olivia Wong, DO; Yonah Korngold; John Heinegg. Sam Shlomo Spaeth

Disclosures

September 15, 2017

In This Article

Acute Respiratory Failure

Guidelines on acute respiratory failure by the European Respiratory Society/American Thoracic Society [2]

  • Bilevel noninvasive mechanical ventilation (NIV) may be considered in chronic obstructive pulmonary disease (COPD) patients with an acute exacerbation in 3 clinical settings: (1) To prevent acute respiratory acidosis (ie, when the arterial CO2 tension (PaCO2) is normal or elevated but pH is normal); (2) To prevent endotracheal intubation and invasive mechanical ventilation in patients with mild-to-moderate acidosis and respiratory distress, with the aim of preventing deterioration to a point when invasive ventilation would be considered; (3) As an alternative to invasive ventilation in patients with severe acidosis and more severe respiratory distress.

  • Bilevel NIV may also be used as the only method for providing ventilatory support in patients who are not candidates for or decline invasive mechanical ventilation.

  • Bilevel NIV recommended for patients with acute respiratory failure (ARF) leading to acute or acute-on-chronic respiratory acidosis (pH ≤7.35) due to COPD exacerbation.

  • Bilevel NIV recommended in patients considered to require endotracheal intubation and mechanical ventilation, unless the patient is immediately deteriorating.

  • Either bilevel NIV or continuous positive airway pressure (CPAP) recommended for patients with ARF due to cardiogenic pulmonary edema.

  • CPAP or bilevel NIV suggested for patients with ARF due to cardiogenic pulmonary edema in the prehospital setting

  • Early NIV suggested for immunocompromised patients with ARF.

  • NIV suggested for patients with postoperative ARF.

  • Offer NIV to dyspneic patients for palliation in the setting of terminal cancer or other terminal conditions.

  • NIV suggested to be used to prevent post-extubation respiratory failure in high-risk patients.

  • NIV suggested NOT to be used to prevent post-extubation respiratory failure in non-high-risk patients.

  • NIV suggested to be used to facilitate weaning from mechanical ventilation in patients with hypercapnic respiratory failure.

For further reading, see Respiratory Failure

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....