Lili Guan, Luqian Zhou, Jehane Michael Le Grange and Zeguang Zheng contributed equally to this work.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Abkürzungen
HFNO
High-flow nasal oxygen
NIV
Non-invasive ventilation
AHRF
Acute hypoxemic respiratory failure
COVID-19
Coronavirus disease 2019
nCPAP
Nasal continuous positive airway pressure
FiO2
Fraction of inspired oxygen
High-flow nasal oxygen (HFNO) and non-invasive ventilation (NIV) have been used to manage early acute hypoxemic respiratory failure (AHRF) caused by COVID-19. As there is no evidence-based recommendation for the selection of HFNO or NIV, staff tend to base their choice on personal preference (Fig. 1).
×
Frat et al. [1] showed that HFNO was associated with lower 90-day mortality in AHRF patients, which had a strong impact on clinical practice. However, there are some limitations in methodology. Firstly, NIV median daily usage was only 8 h. Furthermore, high expiratory tidal volume (9.2 ± 3.0 mL/kg) and low PEEP (5 cmH2O) may have negative impact on the efficacy of NIV. When considering therapeutic mechanisms, adjustable airway pressure, oxygen consumption, and patient tolerance, nasal continuous positive airway pressure (nCPAP) seems to have advantages and should be considered as the first choice.
Anzeige
As for therapeutic mechanism, HFNO is supposed to generate low PEEP (3 cmH2O on average). However, this pressure level is unstable, uncontrollable, and affected by many factors [2]. In contrast, nCPAP can provide stable and adjustable airway pressure.
When considering constant, high fraction of inspired oxygen (FiO2) and oxygen consumption, HFNO has the advantage of providing stable FiO2. However, it consumes large amounts of oxygen. When FiO2 is set to be 50% and flow to be 50 L/min, 18.4 L/min of 100% oxygen will be consumed. With nCPAP, a mean of 50% FiO2 can be achieved with 5–6 L/min of 100% oxygen delivered directly into the mask. Given current resource limitations, oxygen supply should be an important consideration as patients requiring oxygen increases dramatically.
Patient tolerance when continuously using HFNO or NIV is another consideration, as continuous positive airway pressure without interruption seems important during AHRF, especially early ARDS [3]. HFNO has particular advantage in tolerance. However, nCPAP remains well-tolerated with no patient-ventilator asynchrony.
With regard to concerns that nCPAP may increase risk of transmission, evidence remains controversial. Recent study stated that exhaled air dispersion would also increase during HNFO, theoretically making it no better than nCPAP [4]. In Guangdong, China, no healthcare workers were infected during NIV management under the Chinese guidance of personal protection [5].
Anzeige
In conclusion, there remains paucity evidence on how to choose between HFNO and nCPAP treating mild AHRF due to COVID-19. Theoretically, nCPAP has more advantages. Prospective randomized controlled trials are necessary to compare HFNO with nCPAP to provide more evidence on the indications for different non-invasive respiratory support and also indications for selecting between NIV and intubation.
Acknowledgements
Not applicable.
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.
Akute Brustschmerzen sind ein Alarmsymptom par exellence, schließlich sind manche Auslöser lebensbedrohlich. Auch Kinder klagen oft über Schmerzen in der Brust. Ein Studienteam ist den Ursachen nachgegangen.
Bewegungs-, Dehnungs- und Entspannungsübungen im Wasser lindern die Beschwerden von Patientinnen mit Fibromyalgie besser als das Üben auf trockenem Land. Das geht aus einer spanisch-brasilianischen Vergleichsstudie hervor.
Darauf haben viele Praxen gewartet: Das Zi hat eine Liste von Praxisverwaltungssystemen veröffentlicht, die von Nutzern positiv bewertet werden. Eine gute Grundlage für wechselwillige Ärztinnen und Psychotherapeuten.
Update AINS
Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.