CHEST Guidelines-High-Flow,-Noninvasive-Ventilation-and-Awake-(Noni

High-Flow,-Noninvasive-Ventilation-and-Awake-(Noni

Pdf Summary

The document discusses noninvasive medical techniques for managing patients with COVID-19-induced respiratory failure, focusing on high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), and awake proning. During the COVID-19 pandemic, these procedures, known as aerosol-generating procedures, were initially avoided due to concerns about viral spread. However, experience demonstrated high mortality rates among intubated patients, prompting a reconsideration of noninvasive methods.<br /><br />The article aims to clarify misconceptions about aerosol dispersion with these techniques and provides practical guidance on their use, including indications, contraindications, and application methods. HFNC, which delivers humidified oxygenated gas at high flow rates, offers several advantages over traditional oxygen delivery methods, improving oxygenation and reducing the work of breathing. It is generally more comfortable and better tolerated than NIV, although the latter may be more effective in certain conditions like COPD exacerbations or acute cardiogenic pulmonary edema.<br /><br />Awake proning involves positioning patients to improve ventilation and oxygenation, reducing alveolar over-distention in non-dependent lung areas and collapse in dependent areas. Despite limited studies, there is evidence suggesting that using HFNC or NIV along with awake proning can stabilize respiratory status, potentially avoiding the need for invasive mechanical ventilation.<br /><br />Guidelines vary internationally, with some recommending cautious use of these noninvasive techniques under appropriate conditions, particularly with adequate protective measures against viral transmission. The document further highlights the importance of closely monitoring patients with COVID-19 on HFNC or NIV and suggests that negative-pressure rooms or appropriate filtration systems and personal protective equipment (PPE) should be used to minimize infection risks to healthcare providers. The overall goal is to manage respiratory failure effectively while ensuring the safety of both patients and healthcare workers.

Keywords

noninvasive medical techniques

COVID-19 respiratory failure

high-flow nasal cannula

noninvasive ventilation

awake proning

aerosol-generating procedures

oxygenation

patient safety

viral transmission

respiratory management