Respiratory Care

High-flow oxygen therapy, noninvasive ventilation, invasive mechanical ventilation:

Optimal respiratory care requires optimal technique

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It’s a challenge to keep up with the latest innovations in hospital respiratory care: high-flow oxygen therapy (HFT), noninvasive ventilation (NIV), invasive mechanical ventilation (IMV). While often complementary, these techniques aren’t always interchangeable. Understanding which technique is appropriate and when, can help improve patient care and assist clinical teams for success.
    High flow therapy

    High flow therapy (HFT) delivers:

    • Appropriate flow demand
    • Wide range of FiO2
    • Small PEEP effect
    • CO2 washout
    • Heated humidification
    Noninvasive ventilation support

    Noninvasive ventilation (NIV) support delivers:

    • Appropriate noninvasive ventilatory support
    • Adjustable IPAP (Pressure Support) levels
    • Adjustable EPAP (PEEP) levels
    • Back-up rate
    • Wide range of FiO2
    • Patient monitored parameters and alarms
    • The same physiological effect as invasive mechanical ventilation

    Determine the optimal respiratory technique for optimal care

    Managing patients in respiratory failure - from the very mild to the very severe – presents a range of options to consider. Clinicians can utilize them based upon the need for oxygenation support alone, or the need for both oxygenation support and ventilation support. HFT provides a high level of oxygenation support, but only limited and somewhat variable ventilation support. NIV provides both oxygenation support and ventilation support. Other factors such as the patient interface and device performance can be considerations in determining when to use a particular modality, once oxygenation and ventilatory needs are addressed.

    Click the respiratory technique below to align with patient severity.

    Timely transition of therapies is important - whether escalation or de-escalation of therapy - or providing HFT between NIV sessions. Although the ability to escalate therapy is important, preventing the delay of intubation in patients who need invasive mechanical ventilation requires understanding and recognition of predictors of failure.
    non-inferiority study icon

                    In a recent non-inferiority study,

    87%

                    of patients who were placed on
                    NIV after failing on HFT avoided
                    intubation.3

    non-inferiority study icon

    In a recent non-inferiority study,

    87%

    of patients who were placed on NIV after failing on HFT avoided intubation.3

    Clinical insights

    Are HFOT and NIV complementary for acute respiratory failure?

    FJ Belda, MD, PhD

    Providing evidence- based care to patients in need of respiratory support

    T Piraino, RRT, FCSRT

    Evidence-based practice for noninvasive ventilation and high flow nasal cannula

    T Piraino, RRT, FCSRT

    Webinar: High flow nasal cannula and non-invasive ventilation

     

    T Piraino, RRT, FCSRT

    High Flow Nasal Cannula and Non-Invasive Ventilation: Current Evidence and Practice

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    Succeed in respiratory care: NIV and
    high-flow oxygen therapy
     

    Philips Respironics V60 noninvasive ventilator

    References:
    1. Drake. High-Flow Nasal Cannula Oxygen in Adult: An Evidence-based Assessment. Ann Am Thoracic Society. 2018;15(2): 145-155.

    2. Schmidt, Pellegrino, Combes, Scheinkestel, Cooper, Hodgson. Mechanical ventilation during extracorporeal membrane oxygenation. Critical Care. 2014;18:203.

    3. Piraino. Noninvasive Respiratory Support in Acute Hypoxemic Respiratory Failure. Respir Care 2019;64(6):638 –646.

    4. Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7382.185;

    5. Experiences of noninvasive ventilation in adults with hypercapnic respiratory failure: a review of evidence. Hamadziripi Ngandu, Nichola Gale, Jane B. Hopkinson; European Respiratory Review Dec 2016, 25 (142) 451-471; DOI: 10.1183/16000617.0002-2016