High-flow oxygen therapy and other inhaled therapies in intensive care units

Summary In this Series paper, we review the current evidence for the use of high-flow oxygen therapy, inhaled gases, and aerosols in the care of critically ill patients. The available evidence supports the use of high-flow nasal cannulae for selected patients with acute hypoxaemic respiratory failur...

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Veröffentlicht in:The Lancet (British edition) 2016-04, Vol.387 (10030), p.1867-1878
Hauptverfasser: Levy, Sean D, MD, Alladina, Jehan W, MD, Hibbert, Kathryn A, MD, Harris, R Scott, MD, Bajwa, Ednan K, MD, Hess, Dean R, RRT
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container_end_page 1878
container_issue 10030
container_start_page 1867
container_title The Lancet (British edition)
container_volume 387
creator Levy, Sean D, MD
Alladina, Jehan W, MD
Hibbert, Kathryn A, MD
Harris, R Scott, MD
Bajwa, Ednan K, MD
Hess, Dean R, RRT
description Summary In this Series paper, we review the current evidence for the use of high-flow oxygen therapy, inhaled gases, and aerosols in the care of critically ill patients. The available evidence supports the use of high-flow nasal cannulae for selected patients with acute hypoxaemic respiratory failure. Heliox might prevent intubation or improve gas flow in mechanically ventilated patients with severe asthma. Additionally, it might improve the delivery of aerosolised bronchodilators in obstructive lung disease in general. Inhaled nitric oxide might improve outcomes in a subset of patients with postoperative pulmonary hypertension who had cardiac surgery; however, it has not been shown to provide long-term benefit in patients with acute respiratory distress syndrome (ARDS). Inhaled prostacyclins, similar to inhaled nitric oxide, are not recommended for routine use in patients with ARDS, but can be used to improve oxygenation in patients who are not adequately stabilised with traditional therapies. Aerosolised bronchodilators are useful in mechanically ventilated patients with asthma and chronic obstructive pulmonary disease, but are not recommended for those with ARDS. Use of aerosolised antibiotics for ventilator-associated pneumonia and ventilator-associated tracheobronchitis shows promise, but the delivered dose can be highly variable if proper attention is not paid to the delivery method.
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The available evidence supports the use of high-flow nasal cannulae for selected patients with acute hypoxaemic respiratory failure. Heliox might prevent intubation or improve gas flow in mechanically ventilated patients with severe asthma. Additionally, it might improve the delivery of aerosolised bronchodilators in obstructive lung disease in general. Inhaled nitric oxide might improve outcomes in a subset of patients with postoperative pulmonary hypertension who had cardiac surgery; however, it has not been shown to provide long-term benefit in patients with acute respiratory distress syndrome (ARDS). Inhaled prostacyclins, similar to inhaled nitric oxide, are not recommended for routine use in patients with ARDS, but can be used to improve oxygenation in patients who are not adequately stabilised with traditional therapies. 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Use of aerosolised antibiotics for ventilator-associated pneumonia and ventilator-associated tracheobronchitis shows promise, but the delivered dose can be highly variable if proper attention is not paid to the delivery method.</description><identifier>ISSN: 0140-6736</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/S0140-6736(16)30245-8</identifier><identifier>PMID: 27203510</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject><![CDATA[Administration, Inhalation ; Adrenal Cortex Hormones - administration & dosage ; Airway management ; Anti-Bacterial Agents - administration & dosage ; Antibiotics ; Asthma ; Bronchodilator Agents - administration & dosage ; Chronic obstructive pulmonary disease ; Critical Care - methods ; Critical Illness ; Drug dosages ; Helium - administration & dosage ; Hospitals ; Humans ; Hypertension ; Hypertension, Pulmonary - therapy ; Intensive care ; Intensive Care Units ; Internal Medicine ; Intubation ; Lung diseases ; Lung Diseases, Obstructive - therapy ; Lungs ; Nitric oxide ; Nitric Oxide - administration & dosage ; Oxygen ; Oxygen - administration & dosage ; Oxygen Inhalation Therapy - methods ; Oxygen therapy ; Oxygenation ; Pneumonia, Ventilator-Associated - drug therapy ; Prostaglandins I - administration & dosage ; Respiratory distress syndrome ; Respiratory Distress Syndrome, Adult - therapy ; Respiratory therapy ; Ventilation ; Ventilators]]></subject><ispartof>The Lancet (British edition), 2016-04, Vol.387 (10030), p.1867-1878</ispartof><rights>Elsevier Ltd</rights><rights>2016 Elsevier Ltd</rights><rights>Copyright © 2016 Elsevier Ltd. 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subjects Administration, Inhalation
Adrenal Cortex Hormones - administration & dosage
Airway management
Anti-Bacterial Agents - administration & dosage
Antibiotics
Asthma
Bronchodilator Agents - administration & dosage
Chronic obstructive pulmonary disease
Critical Care - methods
Critical Illness
Drug dosages
Helium - administration & dosage
Hospitals
Humans
Hypertension
Hypertension, Pulmonary - therapy
Intensive care
Intensive Care Units
Internal Medicine
Intubation
Lung diseases
Lung Diseases, Obstructive - therapy
Lungs
Nitric oxide
Nitric Oxide - administration & dosage
Oxygen
Oxygen - administration & dosage
Oxygen Inhalation Therapy - methods
Oxygen therapy
Oxygenation
Pneumonia, Ventilator-Associated - drug therapy
Prostaglandins I - administration & dosage
Respiratory distress syndrome
Respiratory Distress Syndrome, Adult - therapy
Respiratory therapy
Ventilation
Ventilators
title High-flow oxygen therapy and other inhaled therapies in intensive care units
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