Acute Respiratory Failure: New Perspectives and Current Clinical Challenges

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: 31 August 2024 | Viewed by 6301

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Department of Anesthesia and Intensive Care, University of Foggia, 71122 Foggia, Italy
Interests: intensive care medicine; anesthesiology; cardiopulmonary resuscitation; critical care medicine; patient blood management; perioperative medicine
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Special Issue Information

Dear Colleagues,

Acute respiratory failure (ARF) patients represent the widest cluster of those critically ill in ICU. Current recommended MV strategies include the use of a tidal volume of 4–6 mL/kg of predicted body weight (PBW) and a plateau pressure (Pplat) below 27 cmH2O, with a driving pressure (Pdrive) below 15 cmH2O, to mitigate the risk of ventilator-induced lung injury (VILI), reduce the onset of patient self-inflicted lung injury (P-SILI) and improve outcomes. To date, Pdrive, transpulmonary pressure, and mechanical power have been proposed as markers to quantify the risk of VILI and optimize ventilator settings, whereas no strategies for individualizing positive-end expiratory pressure (PEEP) have proven superior for improving survival. Several rescue therapies, including neuromuscular blockade, prone positioning, recruitment maneuvers (RMs), vasodilators, and extracorporeal membrane oxygenation (ECMO), may be considered to treat severe ARF. New ventilator strategies such as airway pressure release ventilation (APRV) and time-controlled adaptive ventilation (TCAV) have demonstrated potential benefits to reduce VILI. Non-invasive ventilation (NIV) and high-flow nasal oxygen (HFNO) have become further cornerstones of ARF treatment, mainly after the COVID-19 pandemic, as they help to avoid the risks related to intubation and prolonged mechanical ventilation. Future perspectives and current clinical changes are focused especially on less-invasive monitoring, such as electrical impedance tomography (EIT) and lung and diaphragm ultrasound, in order to have an easier and faster approach to treatment and no delay in the escalation of therapies. The final aim remains avoiding ARF progression and promoting a better survival after ICU recovery.

Prof. Dr. Gilda Cinnella
Guest Editor

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Keywords

  • ARF
  • mechanical ventilation
  • VILI
  • PSILI
  • NIV
  • HFNO
  • weaning
  • EIT
  • lung US

Published Papers (2 papers)

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Research

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11 pages, 927 KiB  
Article
High-Flow Nasal Cannula Oxygen Therapy versus Non-Invasive Ventilation in AIDS Patients with Acute Respiratory Failure: A Randomized Controlled Trial
by Jingjing Hao, Jingyuan Liu, Lin Pu, Chuansheng Li, Ming Zhang, Jianbo Tan, Hongyu Wang, Ningning Yin, Yao Sun, Yufeng Liu, Hebing Guo and Ang Li
J. Clin. Med. 2023, 12(4), 1679; https://doi.org/10.3390/jcm12041679 - 20 Feb 2023
Cited by 2 | Viewed by 2637
Abstract
Background: Acute respiratory failure (ARF) remains the most common diagnosis for intensive care unit (ICU) admission in acquired immunodeficiency syndrome (AIDS) patients. Methods: We conducted a single-center, prospective, open-labeled, randomized controlled trial at the ICU, Beijing Ditan Hospital, China. AIDS patients with ARF [...] Read more.
Background: Acute respiratory failure (ARF) remains the most common diagnosis for intensive care unit (ICU) admission in acquired immunodeficiency syndrome (AIDS) patients. Methods: We conducted a single-center, prospective, open-labeled, randomized controlled trial at the ICU, Beijing Ditan Hospital, China. AIDS patients with ARF were enrolled and randomly assigned in a 1:1 ratio to receive either high-flow nasal cannula (HFNC) oxygen therapy or non-invasive ventilation (NIV) immediately after randomization. The primary outcome was the need for endotracheal intubation on day 28. Results: 120 AIDS patients were enrolled and 56 patients in the HFNC group and 57 patients in the NIV group after secondary exclusion. Pneumocystis pneumonia (PCP) was the main etiology for ARF (94.7%). The intubation rates on day 28 were similar to HFNC and NIV (28.6% vs. 35.1%, p = 0.457). Kaplan–Meier curves showed no statistical difference in cumulative intubation rates between the two groups (log-rank test 0.401, p = 0.527). The number of airway care interventions in the HFNC group was fewer than in the NIV group (6 (5–7) vs. 8 (6–9), p < 0.001). The rate of intolerance in the HFNC group was lower than in the NIV group (1.8% vs. 14.0%, p = 0.032). The VAS scores of device discomfort in the HFNC group were lower than that in the NIV group at 2 h (4 (4–5) vs. 5 (4–7), p = 0.042) and at 24 h (4 (3–4) vs. 4 (3–6), p = 0.036). The respiratory rate in the HFNC group was lower than that in the NIV group at 24 h (25 ± 4/min vs. 27 ± 5/min, p = 0.041). Conclusions: Among AIDS patients with ARF, there was no statistical significance of the intubation rate between HFNC and NIV. HFNC had better tolerance and device comfort, fewer airway care interventions, and a lower respiratory rate than NIV. Clinical Trial Number: Chictr.org (ChiCTR1900022241). Full article
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Review

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17 pages, 921 KiB  
Review
High-Flow Oxygen Therapy in the Perioperative Setting and Procedural Sedation: A Review of Current Evidence
by Lou’i Al-Husinat, Basil Jouryyeh, Ahlam Rawashdeh, Abdelrahman Alenaizat, Mohammad Abushehab, Mohammad Wasfi Amir, Zaid Al Modanat, Denise Battaglini and Gilda Cinnella
J. Clin. Med. 2023, 12(20), 6685; https://doi.org/10.3390/jcm12206685 - 23 Oct 2023
Cited by 1 | Viewed by 3226
Abstract
High-flow oxygen therapy (HFOT) is a respiratory support system, through which high flows of humidified and heated gas are delivered to hypoxemic patients. Several mechanisms explain how HFOT improves arterial blood gases and enhances patients’ comfort. Some mechanisms are well understood, but others [...] Read more.
High-flow oxygen therapy (HFOT) is a respiratory support system, through which high flows of humidified and heated gas are delivered to hypoxemic patients. Several mechanisms explain how HFOT improves arterial blood gases and enhances patients’ comfort. Some mechanisms are well understood, but others are still unclear and under investigation. HFOT is an interesting oxygen-delivery modality in perioperative medicine that has many clinical applications in the intensive care unit (ICU) and the operating room (OR). The purpose of this article was to review the literature for a comprehensive understanding of HFOT in the perioperative period, as well as its uses in procedural sedation. This review will focus on the HFOT definition, its physiological benefits, and their mechanisms, its clinical uses in anesthesia, and when it is contraindicated. Full article
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