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 |
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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. |
doi_str_mv | 10.1016/S0140-6736(16)30245-8 |
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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. 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.</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. All rights reserved.</rights><rights>Copyright Elsevier Limited Apr 30, 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c514t-f0b1cbe923073a573d7c4843c4bba324549dc7d5a156591ea772a0e7b71f67b33</citedby><cites>FETCH-LOGICAL-c514t-f0b1cbe923073a573d7c4843c4bba324549dc7d5a156591ea772a0e7b71f67b33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1786330835?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27203510$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Levy, Sean D, MD</creatorcontrib><creatorcontrib>Alladina, Jehan W, MD</creatorcontrib><creatorcontrib>Hibbert, Kathryn A, MD</creatorcontrib><creatorcontrib>Harris, R Scott, MD</creatorcontrib><creatorcontrib>Bajwa, Ednan K, MD</creatorcontrib><creatorcontrib>Hess, Dean R, RRT</creatorcontrib><title>High-flow oxygen therapy and other inhaled therapies in intensive care units</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><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.</description><subject>Administration, Inhalation</subject><subject>Adrenal Cortex Hormones - administration & dosage</subject><subject>Airway management</subject><subject>Anti-Bacterial Agents - administration & dosage</subject><subject>Antibiotics</subject><subject>Asthma</subject><subject>Bronchodilator Agents - administration & dosage</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Critical Care - methods</subject><subject>Critical Illness</subject><subject>Drug dosages</subject><subject>Helium - administration & dosage</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypertension, Pulmonary - therapy</subject><subject>Intensive care</subject><subject>Intensive Care Units</subject><subject>Internal Medicine</subject><subject>Intubation</subject><subject>Lung diseases</subject><subject>Lung Diseases, Obstructive - 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administration & dosage</topic><topic>Airway management</topic><topic>Anti-Bacterial Agents - administration & dosage</topic><topic>Antibiotics</topic><topic>Asthma</topic><topic>Bronchodilator Agents - administration & dosage</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Critical Care - methods</topic><topic>Critical Illness</topic><topic>Drug dosages</topic><topic>Helium - administration & dosage</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Hypertension, Pulmonary - therapy</topic><topic>Intensive care</topic><topic>Intensive Care Units</topic><topic>Internal Medicine</topic><topic>Intubation</topic><topic>Lung diseases</topic><topic>Lung Diseases, Obstructive - therapy</topic><topic>Lungs</topic><topic>Nitric oxide</topic><topic>Nitric Oxide - administration & dosage</topic><topic>Oxygen</topic><topic>Oxygen - administration & dosage</topic><topic>Oxygen Inhalation Therapy - methods</topic><topic>Oxygen therapy</topic><topic>Oxygenation</topic><topic>Pneumonia, Ventilator-Associated - 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Academic</collection><jtitle>The Lancet (British edition)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Levy, Sean D, MD</au><au>Alladina, Jehan W, MD</au><au>Hibbert, Kathryn A, MD</au><au>Harris, R Scott, MD</au><au>Bajwa, Ednan K, MD</au><au>Hess, Dean R, RRT</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>High-flow oxygen therapy and other inhaled therapies in intensive care units</atitle><jtitle>The Lancet (British edition)</jtitle><addtitle>Lancet</addtitle><date>2016-04-30</date><risdate>2016</risdate><volume>387</volume><issue>10030</issue><spage>1867</spage><epage>1878</epage><pages>1867-1878</pages><issn>0140-6736</issn><eissn>1474-547X</eissn><coden>LANCAO</coden><abstract>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.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>27203510</pmid><doi>10.1016/S0140-6736(16)30245-8</doi><tpages>12</tpages></addata></record> |
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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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