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Added Benefit of Noninvasive Ventilation to High-Flow Nasal Oxygen to Prevent Reintubation in Higher-Risk Patients

Added Benefit of Noninvasive Ventilation to High-Flow Nasal Oxygen to Prevent Reintubation in... Opinion EDITORIAL Added Benefit of Noninvasive Ventilation to High-Flow Nasal Oxygen to Prevent Reintubation in Higher-Risk Patients Irene Telias, MD; Niall D. Ferguson, MD, MSc Liberating patients from ongoing invasive mechanical venti- tion and is strongly recommended in recent guidelines. How- lation is typically a 3-step process. First, clinicians must rec- ever, some patients cannot tolerate NIV at all, and others re- ognize that patients may no longer require mechanical quire frequent breaks or interruptions. A newer technique is ventilation—ie, when the reasons for intubation are substan- the use of high-flow nasal oxygen (HFNO), which delivers high tially improved and a num- flows of warm humidified gas and can decrease work by con- ber of clinical stability crite- tributing to clearance of secretions, providing low levels of posi- Related article page 1465 ria are met. Second, patients tive end-expiratory pressure and decreasing dead-space by car- who meet these “readiness to wean” criteria are then bon dioxide washout in the upper airway. HFNO has been assessed for their ability to breathe through the endotracheal shown to be more comfortable than standard oxygen and to tube with little or no assistance from the ventilator during a reduce the need for reintubation http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Added Benefit of Noninvasive Ventilation to High-Flow Nasal Oxygen to Prevent Reintubation in Higher-Risk Patients

JAMA , Volume 322 (15) – Oct 15, 2019

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Publisher
American Medical Association
Copyright
Copyright 2019 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2019.14609
Publisher site
See Article on Publisher Site

Abstract

Opinion EDITORIAL Added Benefit of Noninvasive Ventilation to High-Flow Nasal Oxygen to Prevent Reintubation in Higher-Risk Patients Irene Telias, MD; Niall D. Ferguson, MD, MSc Liberating patients from ongoing invasive mechanical venti- tion and is strongly recommended in recent guidelines. How- lation is typically a 3-step process. First, clinicians must rec- ever, some patients cannot tolerate NIV at all, and others re- ognize that patients may no longer require mechanical quire frequent breaks or interruptions. A newer technique is ventilation—ie, when the reasons for intubation are substan- the use of high-flow nasal oxygen (HFNO), which delivers high tially improved and a num- flows of warm humidified gas and can decrease work by con- ber of clinical stability crite- tributing to clearance of secretions, providing low levels of posi- Related article page 1465 ria are met. Second, patients tive end-expiratory pressure and decreasing dead-space by car- who meet these “readiness to wean” criteria are then bon dioxide washout in the upper airway. HFNO has been assessed for their ability to breathe through the endotracheal shown to be more comfortable than standard oxygen and to tube with little or no assistance from the ventilator during a reduce the need for reintubation

Journal

JAMAAmerican Medical Association

Published: Oct 15, 2019

References