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Noninvasive approach for de novo acute hypoxemic respiratory failure

noninvasive ventilation, high-flow nasal cannula, both or none?

García-de-Acilu, Marinaa; Patel, Bhakti K.b; Roca, Oriola,c

Current Opinion in Critical Care: February 2019 - Volume 25 - Issue 1 - p 54–62
doi: 10.1097/MCC.0000000000000570
RESPIRATORY SYSTEM: Edited by Laurent J. Brochard and Tài Pham

Purpose of review To summarize the recent evidence regarding the use of noninvasive strategies for de novo acute hypoxemic respiratory failure (AHRF).

Recent findings New guidelines for the use of noninvasive ventilation (NIV) in acute respiratory failure have been published. In parallel, high-flow nasal cannula (HFNC) is an emerging noninvasive strategy for AHRF patients. Although some have cautioned against the use of NIV in AHRF, new encouraging data about the use of a helmet interface for NIV in acute respiratory distress syndrome may overcome the limitations of facemask NIV.

Summary In the last two decades, the use of NIV and HFNC in patients with AHRF has considerably expanded, changing the paradigm of management of AHRF. Choice of each technique should be based according to centre experience and patient tolerability. However, when using noninvasive strategies for AHRF, it is crucial to predefine specific criteria for intubation and monitor patients closely for early detection of clinical deterioration to avoid delayed intubation.

aCritical Care Department, Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain

bDepartment of Medicine, Section of Pulmonary/Critical Care, University of Chicago, Chicago, Illinois, USA

cCiber Enfermedades Respiratorias (Ciberes), Instituto de Salud Carlos III, Madrid, Spain

Correspondence to Oriol Roca, MD, PhD, Critical Care Department, Vall d’Hebron University Hospital, P. Vall d’Hebron 119-129, 08035 Barcelona, Spain. E-mail:

Received 5 September, 2018

Accepted 11 November, 2018

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