© 2016 por GTVMNI

R. Artacho Ruiza, B. Artacho Juradoc, F. Caballero Güetoa, A. Cano Yuste, I. Durbán García, F. García Delgado et al. Med Intensiva. 2019

Este estudio, liderado por Rafael Artacho, arroja luz sobre qué predictores de éxito deberíamos buscar cuando aplicamos terapia de alto flujo con cánula nasal. Una FR inferior a 29 respiraciones/min a la segunda hora de tratamiento y una FiO2 inferior a 0,59 e IROX superior a 5,98 a las 8 h se asociaron a éxito de la CNAF en el FRA hipoxémico. El fracaso de la técnica conlleva una mayor estancia y mortalidad en la UCI y una mayor necesidad de VM.

Carratalá Perales JM, Díaz Lobato S, Brouzet B, Más-Serrano P, Espinosa B, Llorens P. Emergencias. 2018;30:395-399

Carratala et al. publican en este número de EMERGENCIAS un interesante estudio retrospectivo en el que describen las ventajas de usar CNAF en una cohorte de pacientes con insuficiencia cardiaca grave, en la mayoría de ellos con fines paliativos. Los efectos adversos fueron mínimos y contribuyeron al confort de pacientes en situación de fragilidad. Los autores reconocen sus limitaciones, y dados los sesgos inherentes a los estudios observacionales, estaría indicado un ensayo clínico aleatorio en el que se evaluara el grado de fragilidad y la satisfacción del paciente. En realidad, es una demostración de las oportunidades de colaboración multidisciplinaria y trabajo transversal entre áreas de conocimiento y ámbitos asistenciales aparentemente alejados, como la atención a críticos y la medicina paliativa.

Josep Masip,W. Frank Peacock, Susanna Price, Louise Cullen, F. Javier Martin-Sanchez, Petar Seferovic et al. European Heart Journal, Volume 39, Issue 1, 1 January 2018, Pages 17–25.

In acute heart failure (AHF) syndromes significant respiratory failure (RF) is essentially seen in patients with acute cardiogenic pulmonary oedema (ACPE) or cardiogenic shock (CS). Non-invasive ventilation (NIV), the application of positive intrathoracic pressure through an interface, has shown to be useful in the treatment of moderate to severe RF in several scenarios. There are two main modalities of NIV: continuous positive airway pressure (CPAP) and pressure support ventilation (NIPSV) with positive end expiratory pressure. Appropriate equipment and experience is needed for NIPSV, whereas CPAP may be administered without a ventilator, not requiring special training. Both modalities have shown to be effective in ACPE, by a reduction of respiratory distress and the endotracheal intubation rate compared to conventional oxygen therapy, but the impact on mortality is less conclusive. The new modality ‘high-flow nasal cannula’ seems promising in cases of AHF with less severe RF.

Rochwerg B, Brochard L, Elliott MW, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J 2017; 50: 1602426

This guideline committee developed recommendations for 11 actionable questions in a PICO (population–intervention–comparison–outcome) format, all addressing the use of NIV for various aetiologies of ARF. The specific conditions where recommendations were made include exacerbation of chronic obstructive pulmonary disease, cardiogenic pulmonary oedema, de novo hypoxaemic respiratory failure, immunocompromised patients, chest trauma, palliation, post-operative care, weaning and post-extubation.

Davidson AC, Banham S, Elliott M, et al. Thorax 2016;71:1–35.

The aim of the guideline is to draw attention to the evidence of suboptimal care in AHRF in the UK, provide an overview of the evidence supporting the use of invasive and non-invasive ventilation, encourage better communication between admitting clinicians and critical care services, promote the use of AHRF patient pathways, and improve resourcing, training, outcomes and patient experience for all adults who develop AHRF.

Bhakti K. Patel, MD1; Krysta S. Wolfe, MD1; Anne S. Pohlman, MSN1; et al. JAMA. 2016;315(22):2435-2441

Among patients with ARDS, treatment with helmet NIV resulted in a significant reduction of intubation rates. There was also a statistically significant reduction in 90-day mortality with helmet NIV. Multicenter studies are needed to replicate these findings.

Free access

Gonzalo Hernández, Concepción Vaquero, Laura González et al. JAMA. Published online October 5, 2016. doi:10.1001/jama.2016.14194

  • Question Is high-flow nasal cannula noninferior to noninvasive ventilation for preventing reintubation and postextubation respiratory failure?

  • Findings In this multicenter randomized noninferiority clinical trial that included 604 adults, the proportion requiring reintubation was 22.8% with high-flow therapy vs 19.1% with noninvasive ventilation, and postextubation respiratory failure was observed in 26.9% with high-flow therapy vs 39.8% with noninvasive ventilation, reaching the noninferiority threshold.

  • Meaning High-flow nasal cannula immediately after scheduled extubation was not inferior to noninvasive mechanical ventilation for risk of reintubation and postextubation respiratory failure in patients at high risk of reintubation.

Free access

Gonzalo Hernández, Concepción Vaquero, Paloma González et al. JAMA. 2016;315(13):1354-1361

Among extubated patients at low risk for reintubation, the use of high-flow nasal cannula oxygen compared with conventional oxygen therapy reduced the risk of reintubation within 72 hours.

Jean-Pierre Frat, M.D et al. N Engl J Med 2015; 372:2185-2196. June 4, 2015

In patients with nonhypercapnic acute hypoxemic respiratory failure, treatment with high-flow oxygen, standard oxygen, or noninvasive ventilation did not result in significantly different intubation rates. There was a significant difference in favor of high-flow oxygen in 90-day mortality.

Access includes the video, a text summary PDF, and other features

Christopher R. Kelly, M.D., Andrew R. Higgins, M.D., and Subani Chandra, M.D. N Engl J Med 2015; June 4, 2015

This video demonstrates noninvasive positive-pressure ventilation. In certain conditions, this technique offers the benefits of invasive ventilation with fewer of the risks that are associated with intubation.

Free access

Mosier JM et al. Annals of Emergency Medicine. November 2015. Volume 66, Issue 5, Pages 529–541

Noninvasive ventilation is commonly used for patients with respiratory failure and has been demonstrated to improve outcomes in acute exacerbations of chronic obstructive lung disease and congestive heart failure, but should be used carefully, if at all, in the management of asthma, pneumonia, and acute respiratory distress syndrome. This review article summarizes the pathophysiology of acute respiratory failure, management options, and rescue therapies including airway pressure release ventilation, continuous neuromuscular blockade, inhaled nitric oxide, and extracorporeal membrane oxygenation.

Edición: 2ª
Coordinadores: J.F. Lora Martínez, J.A. Minaya García. Grupo de Trabajo de VMNI
Editorial: Aula Médica

Año publicación: 2015

Please reload