Thread by @GasBugZa

Next up is (my office-mate - yes I'm showing off) Dr Susan Murphy @susan_icu talking about 'Preventing Intubation'.
#CCSSA2022 #critcare #FOAMcc

So how can we divide patients in whom we want to prevent intubation
- Those we want to prevent primarily intubating (e.g. a patient with acute hypoxaemic respiratory failure)
- THose who were previously intubated who you want to avoid re-intubating
#CCSSA2022

Often to try prevent intubation, we consider alternative types of respiratory support, which include:
- Simple Oxygen Delivery
- High Flow Humidified Oxygen
- Non-Invasive Ventilation
- Continuous Positive Airway Pressure
#CCSSA2022

When is it not appropriate
- if inadequate patient monitoring
- multi-organ support required
- acute indications for intubation are present
#CCSSA2022

High Flow Oxygen
- better than O2 therapy alone
- humidified
- any have advantages over CPAP and NIV in some conditions
doi.org/10.1001/jama.2…
#CCSSA2022

With regards to acute respiratory failure, most of the early work was in acute viral bronchiolitis in paeds. HFO2 has positive clinical effects on various resp parameters, a decreased need for CPAP, and is used in mild and severe bronchiolitis.
doi.org/10.1016/j.amsu…
#CCSSA2022

The big danger is that there is delay to intubation because an intervention has been implemented. These patients have to be monitored. The ROX index is validated in adults, not yet in paeds.
doi.org/10.1007/s00134…
#CCSSA2022

Other respiratory indications for HFO2 include
- acute severe asthma
- Peri-intubation
- Obstructive sleep apnea
- Inhalational burns
- Post-extubation stridor
- Immunocompromised patients (e.g.
- Palliation
#CCSSA2022

Regarding NIV, there are a few adult indications:
COPD
Cardiogenic pulmonary oedema
Obesity Hypoventilation
High Risk of Extubation Failure
Postoperative Hypoxaemia
doi.org/10.5005/jp-jou…
#CCSSA2022

In paeds, NIV has been used in
Acute Lung Injury/pARDS
Extrathoracic Airway Obstruction
Neuromuscular Weakness
Obstructive/Restrictive Lung Disease
doi.org/10.5005/jp-jou…
#CCSSA2022