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Noninvasive respiratory support in the hypoxaemic peri-operative/periprocedural patient: A joint ESA/ESICM guideline
Marc Leone1, Sharon Einav, Davide Chiumello
1From the Aix Marseille Université, Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Service d'Anaesthésie et de Réanimation, Marseille, France (ML); Intensive Care Unit of the Shaare Zedek Medical Medical Centre and Hebrew University Faculty of Medicine, Jerusalem, Israel (SE); Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa and Department of Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa (LB); Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Centro Ricerca Coordinata di Insufficienza Respiratoria, Università degli Studi di Milano, Milan, Italy (DC); General ICUs. Department of Anaesthesia and Critical Care, Pitié-Salpêtrière Hospital, 97 Bd de l'Hopital 7013 Paris, Sorbonne University Medicine, Paris, France (JMC); Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan (SC); Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anaesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo (AC); Department of Surgical and Biomedical Sciences, University of Perugia, Perugia (EDR); Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy (SF); Pulmonary Engineering Group, Department of Anaesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (MGA); Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.). Section of Anaesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy (CG); The Intensive Care Unit of the Shaare Zedek Medical Center, Jerusalem, Israel (YH); Saint Eloi ICU, Montpellier University Hospital and PhyMedExp, INSERM, CNRS, Montpellier, France (SJ); University Department of Medical, Oral and Biotechnological Sciences, Gabriele d'Annunzio University of Chieti-Pescara and Clinical Department of Anaesthesiology and Intensive Care Medicine, SS. Annunziata Hospital, Chieti (SMM); Anaesthesia and Intensive Care Clinic, AOU Policlinico Vittorio Emanuele, Catania (JM); Department of Surgical Sciences and Integrated Diagnostics, University of Genoa and Department of Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa (PP); Department of Anaesthesia and Postoperative Intensive Care, AORN Cardarelli, Naples (GMR); Anaesthesia and Intensive Care Clinic, AOU Policlinico Vittorio Emanuele, Catania, Italy (MS); Department of Paediatric and Obstetric Anaesthesia, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (AA).
Abstract:
: Hypoxaemia is a potential life-threatening yet common complication in the peri-operative and periprocedural patient (e.g. during an invasive procedure with risk of deterioration of gas exchange, such as bronchoscopy). The European Society of Anaesthesiology (ESA) and the European Society of Intensive Care Medicine (ESICM) have developed guidelines for the use of noninvasive respiratory support techniques in the hypoxaemic patient in the peri-operative and periprocedural period. The panel outlined five clinical questions regarding treatment with noninvasive respiratory support techniques [conventional oxygen therapy (COT), high flow nasal cannula (HFNC), noninvasive positive pressure ventilation (NIPPV) and continuous positive airway pressure (CPAP)] for hypoxaemic patients with acute peri-operative/periprocedural respiratory failure. The goal was to assess the available literature on the various noninvasive respiratory support techniques, specifically studies that included adult participants with hypoxaemia in the peri-operative/periprocedural period. The literature search strategy was developed by a Cochrane Anaesthesia and Intensive Care trial search specialist in close collaboration with the panel members and the ESA group methodologist. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the level of evidence and to grade recommendations. The final process was then validated by both ESA and ESICM scientific committees. Among 19 recommendations, the two grade 1B recommendations state that in the peri-operative/periprocedural hypoxaemic patient, the use of either NIPPV or CPAP (based on local expertise) is preferred to COT for improvement of oxygenation; and that the panel suggests using NIPPV or CPAP immediately postextubation for hypoxaemic patients at risk of developing acute respiratory failure after abdominal surgery.
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