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Review
. 2022 Apr 7:15:3121-3132.
doi: 10.2147/IJGM.S294906. eCollection 2022.

Noninvasive Oxygenation in Patients with Acute Respiratory Failure: Current Perspectives

Jean-Pierre Frat  1   2 , Sylvain Le Pape  1 , Rémi Coudroy  1   2 , Arnaud W Thille  1   2
Affiliations
Review

Noninvasive Oxygenation in Patients with Acute Respiratory Failure: Current Perspectives

Jean-Pierre Frat et al. Int J Gen Med. .

Abstract

Purpose of review: High-flow nasal oxygen and noninvasive ventilation are two alternative strategies to standard oxygen in the management of acute respiratory failure.

Discussion: Although high-flow nasal oxygen has gained major popularity in ICUs due to its simplicity of application, good comfort for patients, efficiency in improving oxygenation and promising results in patients with acute hypoxemic respiratory failure, further large clinical trials are needed to confirm its superiority over standard oxygen. Non-invasive ventilation may have deleterious effects, especially in patients exerting strong inspiratory efforts, and no current recommendations support its use in this setting. Protective non-invasive ventilation using higher levels of positive-end expiratory pressure, more prolonged sessions and other interfaces such as the helmet may have beneficial physiological effects leading to it being proposed as alternative to high-flow nasal oxygen in acute hypoxemic respiratory failure. By contrast, non-invasive ventilation is the first-line strategy of oxygenation in patients with acute exacerbation of chronic lung disease, while high-flow nasal oxygen could be an alternative to non-invasive ventilation after partial reversal of respiratory acidosis. Questions remain about the target populations and non-invasive oxygen strategy representing the best alternative to standard oxygen in acute hypoxemic respiratory failure. As concerns acute on-chronic-respiratory failure, the place of high-flow nasal oxygen remains to be evaluated.

Keywords: acute respiratory failure; high-flow nasal oxygen; noninvasive ventilation; respiratory insufficiency.

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Conflict of interest statement

JPF reports grants from French Ministry of Health; travel expenses coverage to attend scientific meetings and consulting fees from Fisher & Paykel and SOS oxygen. SLP reports no conflicts of interest. AWT reports travel expenses coverage to attend scientific meetings and payment for lectures from Fisher & Paykel, Covidien, Maquet-Getinge, and General Electric Healthcare. RC reports travel expenses coverage to attend scientific meetings from Fisher & Paykel and MSD, grants from ERS and SRLF. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Physiological responses of high-flow nasal oxygen therapy and noninvasive ventilation to acute hypoxemic respiratory failure.
See this image and copyright information in PMC

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