Publication: Airway Management in Failure Noninvasive Ventilation in High-Risk Infection
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Date
2023
Journal Title
Noninvasive Mechanical Ventilation in High Risk Infections, Mass Casualty and Pandemics
Journal ISSN
Volume Title
Publisher
Springer International Publishing
Abstract
The COVID outbreak focused the attention of the medical community globally on highly contagious, aerosol-generating respiratory illnesses which were lurking on the horizon since the past decade but the gargantuan pandemic drew the attention of the entire world in management of respiratory diseases. All medical personnel used every ounce of their knowledge, expertise, and resourcefulness to combat the spread of the disease. In this chapter, we have concentrated our attention toward the discussion of management of airway in the scenario of failed noninvasive ventilation in high-risk infections. Intubation causes 6.6-fold increased risk of infection among healthcare workers (HCWs) which further increases in developing countries due to paucity of resources. The initial experiences on COVID-19-related acute hypoxemic respiratory failure (AHRF) from China or the United States showed higher mortality with invasive mechanical ventilation (IMV), prolonged stay on ventilator (ranging from 10 to 17 days), and longer time to wean (causing shortage of ventilators during surge of patients). Although NIV is not recommended for moderate-to-severe acute respiratory distress syndrome (ARDS), the task force of ERS/ATS led by Rochberg et al. (2016) published clinical practice guidelines for noninvasive ventilation in the setting of acute respiratory failure citing strong recommendations for hypercapnia with COPD exacerbation, cardiogenic pulmonary edema. We explored the effect of noninvasive ventilation in the backdrop of the COVID pandemic with conflicting preliminary reports of the use of NIV in COVID-19 with high failure rate in moderate-to-severe ARDS, the fact that it may improve oxygenation in AHRF, temporarily reduce work of breathing with the disadvantages of no effect on natural disease progression, delay in intubation, and IMV in nonexpert hands, a risk of further worsening of the lung injury, especially with higher tidal volumes generated spontaneously in case of inappropriate settings of NIV. In lieu of this, we discussed monitoring of NIV in AHRF, troubleshooting in NIV applications, approach to discontinuation of NIV, special concerns like potentially difficult airway, infection risk, contamination to healthcare personnel, physiologically deteriorating patient on noninvasive ventilation. � The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2014, 2023. All rights reserved.