Risk Stratification in Noninvasive Respiratory Support Failure: A Narrative Review

Area of Science:

• Critical care medicine
• Respiratory therapy
• Nursing education

Background:

• Noninvasive respiratory support (NIRS), including noninvasive ventilation (NIV) and high-flow nasal cannula (HFNC) therapy, is increasingly utilized.
• Failure of NIRS, necessitating invasive mechanical ventilation, is associated with increased mortality rates.
• Existing risk stratification assessments for NIRS failure are limited, with significant variability in study design and outcomes hindering clinical application.

Purpose of the Study:

• To review available risk stratification assessments for NIRS failure.
• To identify common concepts and limitations across existing risk stratification tools.
• To inform critical care nurses about risk assessment strategies for patients receiving NIRS.

Main Methods:

• Systematic review of literature on risk stratification for NIRS failure.
• Analysis of study designs, definitions, terminology, and outcomes in relevant research.
• Identification of common themes and discrepancies in risk assessment methodologies.

Main Results:

• A paucity of validated risk stratification tools exists for predicting NIRS failure.
• Heterogeneity in research methodologies complicates the direct clinical application of current findings.
• Further research is needed to develop and validate broader risk stratification tools for diverse patient populations and NIRS modalities.

Conclusions:

• Enhanced study designs are required for robust risk stratification in NIRS.
• Implementing preventive strategies based on risk assessment can improve patient outcomes.
• Risk stratification facilitates informed patient and family communication regarding NIRS use and potential failure.