Showing posts with label nippv. Show all posts
Showing posts with label nippv. Show all posts

Tuesday, August 27, 2019

High Flow Nasal Cannual vs. Conventional Oxygen Therapy vs. Non-Invasive Positive Pressure Ventilation

Can High-flow Nasal Cannula Reduce the Rate of Endotracheal Intubation in Adult Patients With Acute Respiratory Failure Compared With Conventional Oxygen Therapy and Noninvasive Positive Pressure Ventilation? A Systematic Review and Meta-analysis

I need help with this. Is it me or is this an apples to oranges study? I ask that because the authors compared high flow nasal cannula to conventional oxygen therapy and then they compared HFNC to NIPPV. Okay, the COT versus HFNC is an easy one to settle. Fewer people are going to be intubated if they’re on HFNC, all comers. But the caveats kick in when the authors compare HFNC to NIPPV which many of you know as BiPAP. My issue is because they included patients who were having acute exacerbations of COPD, acute cardiogenic pulmonary edema, asthma exacerbations, and ARDS in the HFNC vs NIV arm of the study. It is my opinion that that’s a bit ridiculous bc we know (and knew in 2017 when this study was published) that those patient populations more often than not need more support than what HFNC can provide. I will say there is data for HFNC in all those settings, but not enough to prove a benefit to NIV. Can you chime in below with your thoughts? I don’t think they should have looked at all comers for HFNC. Taking it by disease processes which other authors have done would yield actual real world results. These devices need to be carefully tailored to the patients you are treating. I’m more than willing to change my mind but I need help. Thanks.  


Link to abstract

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Saturday, July 6, 2019