Asia Ventilation Forum
The Asia Ventilation Forum (AVF) is a not-for-profit organisation comprising members from different Asian countries. We share our knowledge and experience in respiratory care and critical care with intensive care unit (ICU) workers across the continent with the aim of improving care and outcomes for the critically ill. There are two AVF Podcast series. "Behind-The-Scenes ICU Stories" invites colleagues to share anything and everything on their personal experiences. Expect heart-to-heart discussions on topics that may or may not have been widely described in the medical literature. "The Challenges of Airway Management During the Pandemic" invites colleagues to share anything and everything on how they deal with various clinical situations. Expect discussions on how experts personalise evidence-based medicine for the patient at the bedside. These Podcasts are hosted by Dr Jason Phua, respiratory physician and intensivist at Alexandra Hospital, National University Health System, Singapore, and Dr Jose Emmanuel Palo, intensivist at The Medical City, the Philippines.
Asia Ventilation Forum
Noninvasive ventilation and high-flow nasal oxygen for acute hypoxaemic respiratory failure – Dr Domenico Luca Grieco
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AVF
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Season 1
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Episode 5
In this AVF Podcast: ICU Tips & Tricks episode, Dr Domenico Luca Grieco shares his thoughts on noninvasive respiratory support for patients with acute hypoxaemic respiratory failure. Dr Grieco is an intensive care unit (ICU) physician at the Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli, in Rome, Italy. He is the lead author of the landmark HENIVOT trial which compared helmet noninvasive ventilation (NIV) versus high-flow nasal oxygen (HFNO) in patients with the coronavirus disease 2019 (COVID-19), and which was published in the Journal of the American Medical Association (JAMA) in March 2021.
Issues discussed in this interview:
- Physiology underlying support by the helmet NIV, HFNO, and facemask NIV
- A nuanced interpretation of the findings of the HENIVOT trial
- Choosing between the helmet NIV, HFNO, and facemask NIV for acute hypoxaemic respiratory failure
- The importance of close monitoring during noninvasive respiratory support
- Criteria for failure of noninvasive respiratory support and intubation
- Lung-protective ventilation post-intubation
Work cited:
- Grieco DL, Menga LS, Cesarano M, et al. Effect of helmet noninvasive ventilation vs high-flow nasal oxygen on days free of respiratory support in patients with COVID-19 and moderate to severe hypoxemic respiratory failure: the HENIVOT randomized clinical trial. JAMA 2021;325:1731-43.
- Grieco DL, Menga LS, Raggi V, et al. Physiological comparison of high-flow nasal cannula and helmet noninvasive ventilation in acute hypoxemic respiratory failure. Am J Respir Crit Care Med 2020;201:303-12.
- Yoshida T, Fujino Y, Amato MB, Kavanagh BP. Fifty years of research in ARDS. Spontaneous breathing during mechanical ventilation. Risks, mechanisms, and management. Am J Respir Crit Care Med 2017;195:985-92.
- Frat JP, Thille AW, Mercat A, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med 2015;372:2185-96.
- Ehrmann S, Li J, Ibarra-Estrada M, et al. Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure: a randomised, controlled, multinational, open-label meta-trial. Lancet Respir Med 2021.
- Roca O, Caralt B, Messika J, et al. An index combining respiratory rate and oxygenation to predict outcome of nasal high-flow therapy. Am J Respir Crit Care Med 2019;199:1368-76.
- Duan J, Han X, Bai L, Zhou L, Huang S. Assessment of heart rate, acidosis, consciousness, oxygenation, and respiratory rate to predict noninvasive ventilation failure in hypoxemic patients. Intensive Care Med 2017;43:192-9.