Effect of high-flow nasal cannula at different flow rates on diaphragmatic function in subjects recovering from an acute exacerbation of COPD: a physiological prospective pilot study.

BACKGROUND: Noninvasive ventilation (NIV) is widely employed as the initial treatment for patients with chronic acute exacerbation of obstructive pulmonary disease (AECOPD). Nevertheless, high-flow nasal cannula (HFNC) has been increasingly utilized and investigated to mitigate the issues associated with NIV. Flow rate may play a significant role in diaphragmatic function among subjects recovering from AECOPD. Based on these observations, we conducted a physiological study to assess the impact of HFNC therapy on diaphragmatic function, as measured by US, respiratory rate (RR), gas exchange, and patient comfort at various flow rates. METHODS: A prospective physiological pilot study enrolled subjects with a diagnosis of AECOPD who required NIV for more than 24 h. After stabilization, these subjects underwent a 30-min trial using NIV and HFNC at different sequential flow rates (30-60 L/min). At the end of each trial, diaphragmatic displacement (DD, cm) and diaphragmatic thickness fraction (DTF, %) were measured using ultrasound. Additionally, other physiological variables, such as RR, gas exchange, and patient comfort, were recorded. RESULTS: A total of 20 patients were included in the study. DD was no different among trials (p = 0.753). DTF (%) was significantly lower with HFNC-30 L/min compared to HFNC-50 and 60 L/min (p < 0.001 for all comparisons). No significant differences were found in arterial pH and PaCO2 at discontinuation of NIV and at the end of HFNC trials (p > 0.050). During HFNC trials, RR remained unchanged without statistically significant differences (p = 0.611). However, we observed that HFNC improved comfort compared to NIV (p < 0.001 for all comparisons). Interestingly, HFNC at 30 and 40 L/min showed greater comfort during trials. CONCLUSIONS: In subjects recovering from AECOPD and receiving HFNC, flows above 40 L/min may not offer additional benefits in terms of comfort and decreased respiratory effort. HFNC could be a suitable alternative to COT during breaks off NIV.

Lung ultrasound score predicts outcomes in patients with acute respiratory failure secondary to COVID-19 treated with non-invasive respiratory support: a prospective cohort study.

BACKGROUND: Lung ultrasound has demonstrated its usefulness in several respiratory diseases management. One derived score, the Lung Ultrasound (LUS) score, is considered a good outcome predictor in patients with Acute Respiratory Failure (ARF). Nevertheless, it has not been tested in patients undergoing non-invasive respiratory support (NIRS). Taking this into account, the aim of this study is to evaluate LUS score as a predictor of 90-day mortality, ETI (Endotracheal intubation) and HFNC (High Flow Nasal Cannula) failure in patients with ARF due to COVID-19 admitted to a Respiratory Intermediate Care Unit (RICU) for NIRS management. RESULTS: One hundred one patients were admitted to the RICU during the study period. Among these 76% were males and the median age was 55 (45-64) years. Initial ARF management started with HFNC, the next step was the use of Continuous Positive Airway Pressure (CPAP) devices and the last intervention was ETI and Intensive Care Unit (ICU) admission. Of the total study population, CPAP was required in 40%, ETI in 26%, while 15% died. By means of a ROC analysis, a LUS ≥ 25 points was identified as the cut-off point for mortality(AUC 0.81, OR 1.40, 95% CI 1.14 to 1.71; p < 0.001), ETI (AUC 0.83, OR 1.43, 95% CI 1.20 to 1.70; p < 0.001) and HFNC failure (AUC 0.75, OR 1.25, 95% CI 1.12 to 1.41; p < 0.001). Kaplan-Meier survival curves also identified LUS ≥ 25 as a predictor of 90-days mortality (HR 4.16, 95% CI 1.27-13.6) and 30 days ETI as well. CONCLUSION: In our study, a ≥ 25 point cut-off of the Lung Ultrasound Score was identified as a good outcome prediction factor for 90-days mortality, ETI and HFNC failure in a COVID-19 ARF patients cohort treated in a RICU. Considering that LUS score is easy to calculate, a multicenter study to confirm our findings should be performed.

Utilización de soportes respiratorios no invasivos post extubación en pacientes adultos críticos: revisión narrativa SRNI post extubación en adultos críticos / Use of Non-Invasive Respiratory Support in Critically Ill Patients Post-Extubation: a Narrative Review NIRS Post-Extubation in Critically Ill Adults

La tasa de reintubación orotraqueal luego de la extubación se registra entre un 10 a 20%. La aplicación de soportes respiratorios no-invasivos (SRNI) posterior a la extuba-ción como cánula nasal de alto-flujo, ventilación no invasiva (dos niveles de presión) y presión positiva continua en la vía aérea demostraron ser seguras y efectivas post ex-tubación. El período pre-destete representa un momento crucial en el manejo de los pa-cientes críticos ya que el fracaso de la extubación, definido como la necesidad de reintu-bación dentro de los 2 a 7 días, demostró peores resultados al aumentar la mortalidad entre un 25-50%. Esta situación conlleva al requerimiento de ventilación mecánica prolongada, neumonía asociada a la ventilación mecánica y estancias prolongadas de internación. Por lo tanto, es esencial identificar a los pacientes que se beneficiarán utilizando SRNI post extubación.

The rate of re-intubation after extubation is recorded at 10-20%. The use of non-invasive respiratory support (NIRS) post-extubation such as high-flow nasal cannula, non-invasive ventilation (bilevel pressure) and continuous positive airway pressure (CPAP) have been shown to be safe and effective post-extubation. The pre-weaning period represents a crucial time in the management of critically ill patients, as extubation failure, defined as the need for reintubation within 2-7 days, showed worse outcomes with mortality increasing by 25-50%. This situation leads to the requirement for prolonged mechanical ventilation, ventilator-associated pneumonia and long lengths of hospital stay. Therefore, it is essential to identify patients who will benefit from NIRS post extubation.

Terapia nasal de alto flujo durante la exacerbación del asma en sujetos adultos / 18 Terapia nasal de alto flujo durante la exacerbación del asma en sujetos adultos High-flow nasal therapy during asthma exacerbation in adult subjects

El asma es una enfermedad respiratoria crónica frecuente que afecta al 1-18% de la población en diferentes países y secaracteriza por síntomas variables como sibilancias, disnea, opresión torácica, tos y además presentar limitación variable alflujo aéreo espiratorio. Las exacerbaciones moderadas-graves de asma se diagnostican clínicamente por la presencia dedisnea persistente y la obstrucción de las vías respiratorias. En la actualidad, la terapia de oxigenoterapia convencional seutiliza principalmente en entornos clínicos, pero no puede garantizar un soporte respiratorio suficiente, lo que aumenta laprobabilidad de requerir ventilación mecánica no invasiva o en casos donde esté en riesgo la vida del paciente ventilaciónmecánica invasiva. La terapia nasal de alto flujo (TNAF) se introdujo en la práctica clínica y su papel está adquiriendo cadavez más importancia. Sin embargo no se ha descrito su uso en pacientes adultos con exacerbación del asma. Esta revisiónse diseñó para analizar los potenciales fisiológicos de la TNAF y su eficacia en pacientes adultos que cursan exacerbacióndel asma en entornos clínicos.(AU)

Asthma is a common chronic respiratory disease that affects 1-18% of the population in different countries and is characte-rized by variable symptoms such as wheezing, dyspnea, chest tightness, cough, and variable expiratory airflow limitation.Moderate-severe exacerbations of asthma are clinically diagnosed by the presence of persistent dyspnea and airway obs-truction. Currently, conventional oxygen-therapy is mainly used in clinical settings, but it cannot guarantee sufficient respiratorysupport, increasing the likelihood of requiring non-invasive ventilation or in cases where invasive mechanical ventilation islife-threatening. High-flow nasal therapy (HFNT) was introduced into clinical practice and its role is becoming increasinglyimportant. However, its use in adult patients with asthma exacerbation has not been reported. This review aimed to discussthe physiological potentials of HFNT and effectiveness in adult patients with asthma exacerbation in clinical settings.(AU)

Delivery of Aerosolized Bronchodilators by High-Flow Nasal Cannula During COPD Exacerbation.

BACKGROUND: Bronchodilator delivery via a high-flow nasal cannula (HFNC) has generated interest in recent years. The efficacy of in-line vibrating mesh nebulizers with an HFNC during COPD exacerbation is limited. The aim of this study was to evaluate the clinical response of subjects with COPD exacerbation who require bronchodilator therapy (anticholinergic and ß-agonist) by using a vibrating mesh nebulizer in line with an HFNC. METHODS: This was a prospective single-center study performed in a respiratory intermediate care unit that enrolled patients with a diagnosis of COPD exacerbation who required noninvasive ventilation on admission. All the subjects underwent noninvasive ventilation breaks with an HFNC. After clinical stability, pulmonary function tests were performed to assess changes in FEV1 and clinical parameters before and after bronchodilation by using a vibrating mesh nebulizer in line with an HFNC. RESULTS: Forty-six patients with COPD exacerbation were admitted. Five patients who did not use noninvasive ventilation and 10 patients who did not receive bronchodilator treatment with a vibrating mesh nebulizer were excluded. Thirty-one were selected, but 1 subject was secondarily excluded due to loss of data. Finally, 30 subjects were included. The primary outcome was spirometric changes in FEV1. The mean ± SD FEV1 before receiving bronchodilator treatment by using a vibrating mesh nebulizer in line with an HFNC was 0.74 ± 0.10 L, and, after receiving treatment, the mean ± SD FEV1 changed to 0.88 ± 0.12 L (P < .001). Similarly, the mean ± SD FVC increased from 1.75 ± 0.54 L to 2.13 ± 0.63 L (P < .001). Considerable differences were observed in breathing frequency and heart rate after receiving bronchodilator treatment. No relevant changes were observed in the Borg scale or Sp O2 after treatment. The mean clinical stability recorded was 4 d. CONCLUSIONS: In subjects with COPD exacerbation, bronchodilator treatment by using a vibrating mesh nebulizer in line with an HFNC showed a mild but significant improvement in FEV1 and FVC. In addition, a decrease in breathing frequency was observed, suggesting a reduction in dynamic hyperinflation.

COVID-19 Pneumonia and ROX index: Time to set a new threshold for patients admitted outside the ICU.

High flow nasal cannula (HFNC) is used to treat acute hypoxemic respiratory failure (AHRF) even outside the ICU and the ROX index (pulse oximetry/fraction of inspired oxygen/respiratory rate) may predict HFNC failure. OBJECTIVE: The purpose of this investigation was therefore to verify whether the ROX index is an accurate predictor of HFNC failure for COVID-19 patients treated outside the intensive care unit (ICU) and to evaluate the validity of the previously suggested threshold. DESIGN: Multicenter study. Retrospective observational analysis of prospectively collected data. SETTING: 3 centres specialized in non-invasive respiratory support (Buenos Aires, Argentina; Bolzano and Treviso, Italy). Patients treated outside the ICU were analysed MEASUREMENTS: The variables to calculate the ROX index were collected during the first day of therapy at 2, 6, 12 and 24 hours and then recorded every 24 hours. HFNC failure was defined as escalation of respiratory support to invasive mechanical ventilation (IMV) or death. MAIN RESULTS: A total of 35 (29%) patients failed HFNC and required intubation. ROC analysis identified the 12-hour ROX index as the best predictor of intubation with an AUC of 0.7916[CI 95% 0.6905-0.8927] and the best threshold to be 5.99[Specificity 96% Sensitivity 62%]. In the survival analysis, a ROX value <5.99 was associated with an increased risk of failure (p = 0008 log - rank test). The threshold of 4,9 identified by Roca as the best predictor in non-COVID patients, was not able to discriminate between success and failure (p = 0.4 log-rank test) in our patients. CONCLUSIONS: ROX index may be useful in guiding the clinicians in their decision to intubate patients, especially in patients with moderate ARF, treated therefore outside the ICU. Indeed, it also demonstrates a different threshold value than reported for non-COVID patients, possibly related to the different mechanisms of hypoxia.

Combined Noninvasive Respiratory Support Therapies to Treat COVID-19.

BACKGROUND: The roles of high-flow nasal cannula (HFNC) and CPAP in coronavirus disease 2019 (COVID-19) are controversial. The objective of the study was to evaluate the impact of the application of a noninvasive respiratory support algorithm on clinical outcomes in subjects with COVID-19 and with acute respiratory failure. METHODS: We performed a single-center prospective observational study of subjects with respiratory failure from COVID-19 managed with HFNC and with CPAP plus HFNC (combined therapy). The main outcome was the intubation rate, which defined failure of therapy. We also analyzed the role of the ROX index ([[Formula: see text]/[Formula: see text]]/breathing frequency) to predict the need for intubation. RESULTS: From June to December 2020, 113 subjects with COVID-19 respiratory failure were admitted to our respiratory intermediate care unit. HFNC was applied in 65 subjects (57.52%) and combined therapy in 48 subjects (42.47%). A total of 83 subjects (73.45%) were successfully treated with noninvasive respiratory support. The intubation rate was 26.54%, and the overall mortality rate was 14.15%. The mortality rate in subjects who were intubated was 55.2%. An ROX index of 6.28 at 12 h predicted noninvasive respiratory support failure, with 97.6% sensitivity and 51.8% specificity. CONCLUSIONS: Data from our cohort managed in a respiratory intermediate care unit showed that combined noninvasive respiratory support was feasible, with favorable outcomes. Further prospective studies are required.

Resultados preliminares de una unidad de soporte ventilatorio no invasivo en SARS-COV-2 / Preliminary results of a non-invasive ventilatory support unit in SARS-COVID-2

Resumen La utilización de tratamientos de soporte respiratorio no invasivos en la pandemia por COVID-19, es motivo de controversias. El objetivo de este trabajo observacional, fue mostrar la experiencia del primer mes desde la creación de la Unidad de Soporte Ventilatorio no Invasivo (USoVNI) en el Hospital Fernández. Se describe la creación de la unidad, relación profesional de atención-paciente, tipo de habitación, equipo de protección personal modificado, equipamiento de diagnóstico, monitoreo y soporte ventilatorio para tratamiento, criterios de inclusión y algoritmo de tratamiento. Ingresaron 40 pacientes, 25 (63%) derivados de Clínica Médica, 10 (25%) de Emergentología y 5 (13%) de guardia externa. Al ingreso, se calcularon los escores National Early Warning Score, Acute Physiology and Chronic Health Disease Classification System II y Sequential Organ Failure Assessment, con medianas de 12, 8, y 2 puntos, respectivamente. El escore Lung Ultrasonography Score se tomó para cuantificar el compromiso pulmonar ecográficamente. Todos los pacientes ingresaron con máscara con reservorio, y fue estimada una fracción inspirada de O de 80% para el cálculo de la razón presión arterial de O / fracción inspirada de O (Pa/FiO ) de ingreso. El tiempo transcurrido desde el inicio de síntomas hasta el ingreso a la unidad tuvo una mediana de 13 días. El desarrollo de la USoVNI permitió que una gran proporción no fueran trasladados a la Unidad de Terapia Intensiva y podría ser beneficioso para preservar su capacidad. Nuestros resultados sugieren que estas unidades resultarían adecuadas para el tratamiento de la insuficiencia respiratoria aguda grave por COVID-19.

Abstract The use of non-invasive respiratory support in the context of the COVID-19 pandemic is controversial. The aim of this observational study was to show the experience of the first month since the creation of a Non-invasive Ventilatory Support Unit (NIVSU) at Hospital Fernández. We describe the creation of the NIVSU, the health professional-patient ratio, the type of room, the modified personal protection equipment; diagnostic, monitoring and ventilatory support equipment for treatment, as well as the inclusion criteria and the treatment algorithm. Twenty five (63%) of patients were referred from the Internal Medicine Ward, 10 (25%)) from Shock Room, and 5 (13%) from Emergency Ward. National Early Warning Score, Acute Physiology and Chronic Health Disease Classification System II and Sequential Organ Failure Assessment, were calculated on admission, with a median of 12, 8, and 2 points, respectively. The Lung Ultrasonography Score was taken to quantify lung ultrasound findings. All patients were admitted with a reservoir mask, 80% inspired O fraction was estimated for the calculation of arterial O pressure/ inspired O fraction ratio (Pa/FiO ) at admission. The median of time elapsed from the onset of symptoms referred by the patient to UNIT admission was 13 days. The development of NIVSU prevented a large proportion of patients from being transferred to Intensive Care Unit (ICU) and it could be beneficial in preserving ICUs capacity. These early results suggest that non-invasive treatment may be beneficial for the treatment of severe acute respiratory failure by COVID-19.

Fibrosis quística y alto flujo termo humidificado, una nueva estrategia en el tratamiento / High-flow nasal cannula therapy in cystic fibrosis, a New Treatment Strategy

Se presenta el caso de un paciente con fibrosis quística, insuficiencia respiratoria crónica tipo II, en tratamiento con solución hipertónica, DNAsa, salbutamol, VNI nocturna y oxigenoterapia 24 horas, quien consulta por presentar desaturación y cefalea en el contexto de cambio de equipo de VNI. Se inicia tratamiento con HFNC y AVAPS presentando mejoría clínica, disminución de los requerimientos de oxígeno, descenso de la PaCO2 , disminución de los tapones mucosos en la tomografía y fluidificación de las secreciones respiratorias. Se plantea al HFNC como posible estrategia de tratamiento en los pacientes con FQ. Al prevenir el daño de la mucosa, disminuir la inflamación y las infecciones podría enlentecer el deterioro de la función pulmonar.

We present the case of a patient with cystic fibrosis and type II chronic respiratory failure under treatment with hypertonic solution, DNAse, salbutamol, night NIV and 24-hour oxygen therapy. The patient consults for desaturation and cephalea in the context of changing NIV equipment. The patient begins treatment with HHHF and AVAPS and shows clinical improvement, decrease in oxygen requirements, decrease in PaCO2 , less mucous plugging on the tomography and fluidifying of respiratory secretions. The HHHF is proposed as possible treatment strategy for patients with CF. By preventing damage to the mucosa and reducing inflammation and infections it could slow down impairment of the lung function.

[Preliminary results of a non-invasive ventilatory support unit in SARS-COVID-2]. / Resultados preliminares de una unidad de soporte ventilatorio no invasivo en SARS-COV-2.

The use of non-invasive respiratory support in the context of the COVID-19 pandemic is controversial. The aim of this observational study was to show the experience of the first month since the creation of a Non-invasive Ventilatory Support Unit (NIVSU) at Hospital Fernández. We describe the creation of the NIVSU, the health professional-patient ratio, the type of room, the modified personal protection equipment; diagnostic, monitoring and ventilatory support equipment for treatment, as well as the inclusion criteria and the treatment algorithm. Twenty five (63%) of patients were referred from the Internal Medicine Ward, 10 (25%)) from Shock Room, and 5 (13%) from Emergency Ward. National Early Warning Score, Acute Physiology and Chronic Health Disease Classification System II and Sequential Organ Failure Assessment, were calculated on admission, with a median of 12, 8, and 2 points, respectively. The Lung Ultrasonography Score was taken to quantify lung ultrasound findings. All patients were admitted with a reservoir mask, 80% inspired O2 fraction was estimated for the calculation of arterial O2 pressure/ inspired O2 fraction ratio (Pa/FiO2) at admission. The median of time elapsed from the onset of symptoms referred by the patient to UNIT admission was 13 days. The development of NIVSU prevented a large proportion of patients from being transferred to Intensive Care Unit (ICU) and it could be beneficial in preserving ICUs capacity. These early results suggest that non-invasive treatment may be beneficial for the treatment of severe acute respiratory failure by COVID-19.

La utilización de tratamientos de soporte respiratorio no invasivos en la pandemia por COVID-19, es motivo de controversias. El objetivo de este trabajo observacional, fue mostrar la experiencia del primer mes desde la creación de la Unidad de Soporte Ventilatorio no Invasivo (USoVNI) en el Hospital Fernández. Se describe la creación de la unidad, relación profesional de atención-paciente, tipo de habitación, equipo de protección personal modificado, equipamiento de diagnóstico, monitoreo y soporte ventilatorio para tratamiento, criterios de inclusión y algoritmo de tratamiento. Ingresaron 4 0 pacientes, 25 (63%) derivados de Clínica Médica, 10 (25%) de Emergentología y 5 (13%) de guardia externa. Al ingreso, se calcularon los escores National Early Warning Score, Acute Physiology and Chronic Health Disease Classification System II y Sequential Organ Failure Assessment, con medianas de 12, 8, y 2 puntos, respectivamente. El escore Lung Ultrasonography Score se tomó para cuantificar el compromiso pulmonar ecográficamente. Todos los pacientes ingresaron con máscara con reservorio, y fue estimada una fracción inspirada de O2 de 80% para el cálculo de la razón presión arterial de O2/ fracción inspirada de O2 (Pa/FiO2) de ingreso. El tiempo transcurrido desde el inicio de síntomas hasta el ingreso a la unidad tuvo una mediana de 13 días. El desarrollo de la USoVNI permitió que una gran proporción no fueran trasladados a la Unidad de Terapia Intensiva y podría ser beneficioso para preservar su capacidad. Nuestros resultados sugieren que estas unidades resultarían adecuadas para el tratamiento de la insuficiencia respiratoria aguda grave por COVID-19.

Tratamiento con presión positiva de la Apnea Obstructiva del Sueño. Posición de la Asociación Argentina de Medicina Respiratoria / Treatment of Obstructive Sleep Apnea with Positive Pressure. Position of the Argentinian Association of Respiratory Medicine

La Sección de Sueño, Oxigenoterapia y Otros Tratamientos Crónicos Domiciliarios, de la Asociación Argentina de Medicina Respiratoria (AAMR) se planteó desarrollar en nuestro país un documento formal que exponga la base científica y costo económica de la cobertura del tratamiento del síndrome de apneas e hipopneas obstructivas durante el sueño (SAHOS). Esta iniciativa se basó en la necesidad de analizar la visión de expertos locales que se desempeñan en la realidad coyuntural cotidiana de nuestro país, para elaborar un documento informativo para miembros del equipo de salud. A su vez, exhorta a los diferentes actores del sistema a determinar pautas claras que sirvan de referencia para la generación de políticas públicas. La agenda se inició en septiembre de 2018 en un grupo de redacción. Luego, revisores de cinco provincias argentinas efectuaron una extensa valoración de la evidencia publicada. Para la edición final se realizó una reunión presencial de discusión y generación de consenso. Se plantearon como objetivos; actualizar la base científica que define al SAHOS como problema de salud de proporciones epidémicas con consecuencias demostrables en la salud, analizar los datos de costo-efectividad del tratamiento con CPAP para las formas moderadas a severas y leves con síntomas y unificar conceptos en relación con la calidad mínima necesaria en los tratamientos que se ofrecen. Finalmente, se analiza la situación en la Argentina sobre la base a datos publicados y se presenta una propuesta de mejora en tres niveles: social y económico, logístico-administrativo y clínico

The Sleep, Oxygen Therapy and Other Home Chronic Treatments Section of the Argentinian Association of Respiratory Medicine (AAMR, for its acronym in Spanish) proposed the development in our country of a formal document exposing the scientific and cost-economical foundation of the coverage for the treatment of obstructive sleep apnea and hypopnea syndrome (OSAHS). This initiative was based on the need to analyze the vision of local experts who work in the daily current reality of our country, in order to create an informative document for the members of the medical staff. In turn, it encourages the different members of the system to determine clear guidelines that could be used as reference for generating public policies. The agenda began in September, 2018 within a writing staff. Then, editors from five Argentinian provinces made a thorough assessment of published evidence. For the final edition, a face-to-face meeting was arranged to discuss and reach a consensus. The suggested objectives were: to update the scientific base that defines the OSAHS as a health problem of epidemic proportions with health consequences; to analyze cost-efficacy data of CPAP treatment for moderate to severe and mild-with-symptoms forms of the disease and to unify concepts in relation to the minimum necessary quality of treatments to be offered. Finally, the situation in Argentina is analyzed basing on published data, and a proposal is presented for improvement in three levels: social and economic, logistic-administrative and clinical.

Recomendaciones sobre el uso de oxigenoterapia en situaciones especiales / Recommendations on the Use of Oxygen Therapy in Special Situations

La hipoxemia crónica severa se define por la presencia de una presión parcial de oxígeno arterial inferior a 60 mmHg. La oxigenoterapia, es decir el uso terapéutico del oxígeno, consiste en su administración a concentraciones mayores de las que se encuentran en el aire ambiente, con la intención de tratar o prevenir las manifestaciones de la hipoxia. Cuando se prescribe y se usa correctamente, ha demostrado que mejora la sobrevida en pacientes con EPOC e hipoxemia. Ha sido establecido que la oxigenoterapia a largo plazo representa el único tratamiento que mejora la evolución de pacientes con EPOC en etapa avanzada. En particular, dos estudios clave, el NOTT (Nocturnal Oxygen Therapy Trial) y el MRC (British Medical Research Council) hace más de 30 años han demostrado que la oxigenoterapia usada más de 15 horas por día, mejora la sobrevida de pacientes con EPOC severo más hipoxemia en reposo. A pesar de que este concepto se ha extendido por analogía a la insuficiencia respiratoria crónica originada por otras enfermedades respiratorias y no respiratorias, la eficacia de la oxigenoterapia continua no está demostrada claramente en otras entidades. Considerando que el 25% de las prescripciones de oxigenoterapia en nuestro medio no corresponden a pacientes con EPOC e hipoxemia, la Asociación Argentina de Medicina Respiratoria encomendó a un grupo de médicos neumonólogos argentinos la elaboración de la presente normativa, redactada a modo de guía sencilla, sobre el uso de la oxigeno-terapia en “situaciones especiales”, basada en nivel de evidencia por el sistema Grade.

The severe chronic hypoxemia is defined as an arterial partial oxygen pressure measuring less than 60 mmHg. Oxygen therapy is defined as the therapeutic use of oxygen; it consists in oxygen administration at higher concentrations than room air concentrations, to prevent or treat hypoxia. The right use of oxygen therapy has clearly shown to improve survival in hypoxemic chronic obstructive pulmonary disease (COPD) patients. It is well known that long-term oxygen therapy (LTOT) is the only treatment that has been proved to improve the late course of chronic obstructive pulmonary disease. Specially, two landmark studies, the Nocturnal Oxygen Therapy Trial (NOTT) and the British Medical Research Council (MRC) study conducted in the late 1970s have clearly demonstrated that LTOT (when used for more than 15hours/day) improves survival rates in patients with severe COPD associated with hypoxemia at rest. Although this concept has been extended by analogy to chronic respiratory failure caused by respiratory and non-respiratory diseases, continuous oxygen therapy has not been shown to be equally effective in other disorders. Because of 25% of patients who receive oxygen therapy do not have COPD with hypoxemia, the Argentine Association of Respiratory Medicine established a task force of pneumonologists to recommend guidelines about oxygen therapy in “special situations”, based on the level of evidence of the Grades System.

Ventilación mecánica no invasiva en los servicios de emergencias extrahospitalarios / Non-invasive mechanical ventilation in out-of-hospital emergency departments

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