Browsing by Author "Nava, Stefano"

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ERS clinical practice guidelines: high-flow nasal cannula in acute respiratory failure
(2022) Oczkowski, Simon; Ergan, Begum; Bos, Lieuwe; Chatwin, Michelle; Ferrer, Miguel; Gregoretti, Cesare; Heunks, Leo; Frat, Jean-Pierre; Longhini, Federico; Nava, Stefano; Navalesi, Paolo; Ugurlu, Aylin Ozsancak; Pisani, Lara; Renda, Teresa; Thille, Arnaud W.; Winck, Joao Carlos; Windisch, Wolfram; Tonia, Thomy; Boyd, Jeanette; Sotgiu, Giovanni; Scala, Raffaele; 34649974
Background High-flow nasal cannula (HFNC) has become a frequently used noninvasive form of respiratory support in acute settings; however, evidence supporting its use has only recently emerged. These guidelines provide evidence-based recommendations for the use of HFNC alongside other noninvasive forms of respiratory support in adults with acute respiratory failure (ARF). Materials and methodology The European Respiratory Society task force panel included expert clinicians and methodologists in pulmonology and intensive care medicine. The task force used the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methods to summarise evidence and develop clinical recommendations for the use of HFNC alongside conventional oxygen therapy (COT) and noninvasive ventilation (NIV) for the management of adults in acute settings with ARF. Results The task force developed eight conditional recommendations, suggesting the use of 1) HFNC over COT in hypoxaemic ARF; 2) HFNC over NIV in hypoxaemic ARF; 3) HFNC over COT during breaks from NIV; 4) either HFNC or COT in post-operative patients at low risk of pulmonary complications; 5) either HFNC or NIV in post-operative patients at high risk of pulmonary complications; 6) HFNC over COT in nonsurgical patients at low risk of extubation failure; 7) NIV over HFNC for patients at high risk of extubation failure unless there are relative or absolute contraindications to NIV; and 8) trialling NIV prior to use of HFNC in patients with COPD and hypercapnic ARF. Conclusions HFNC is a valuable intervention in adults with ARF. These conditional recommendations can assist clinicians in choosing the most appropriate form of noninvasive respiratory support to provide to patients in different acute settings.
Late Breaking Abstract - WEAning From NonInvasive Ventilation 'WEANIV' Study
(2020) Ugurlu, Aylin Ozsancak; Karakurt, Zuhal; Scala, Raffaele; Ozyilmaz, Ezgi; Ergan, Begum; Nava, Stefano; Dimarco, Fabiano; Tuncay, Eylem; Ciarleglio, Giuseppina; Hasan, Orhan Othman; Betti, Sara; Giuliani, Lisa
Timing of noninvasive ventilation failure: causes, risk factors, and potential remedies
(2014) Ozyilmaz, Ezgi; Ugurlu, Aylin Ozsancak; Nava, Stefano
Background: Identifying the predictors of noninvasive ventilation (NIV) failure has attracted significant interest because of the strong link between failure and poor outcomes. However, very little attention has been paid to the timing of the failure. This narrative review focuses on the causes of NIV failure and risk factors and potential remedies for NIV failure, based on the timing factor. Results: The possible causes of immediate failure (within minutes to <1 h) are a weak cough reflex, excessive secretions, hypercapnic encephalopathy, intolerance, agitation, and patient-ventilator asynchrony. The major potential interventions include chest physiotherapeutic techniques, early fiberoptic bronchoscopy, changing ventilator settings, and judicious sedation. The risk factors for early failure (within 1 to 48 h) may differ for hypercapnic and hypoxemic respiratory failure. However, most cases of early failure are due to poor arterial blood gas (ABGs) and an inability to promptly correct them, increased severity of illness, and the persistence of a high respiratory rate. Despite a satisfactory initial response, late failure (48 h after NIV) can occur and may be related to sleep disturbance. Conclusions: Every clinician dealing with NIV should be aware of these risk factors and the predicted parameters of NIV failure that may change during the application of NIV. Close monitoring is required to detect early and late signs of deterioration, thereby preventing unavoidable delays in intubation.