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Recommendations on the Use of Non-Invasive Ventilation and High Document downloaded from http://www.elsevier.es, day 27/09/2021. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Recommendations on the use of non-invasive ventilation and high flow therapy with nasal cannulas in adult, paediatric and neonatal patients with severe acute respiratory failure. Consensus Document of the Spanish Scientific Societies (SEPAR, SEMICYUC, SEMES; SECIP, SENeo, SEDAR, SENP). Keywords: Non-invasive ventilation, recommendations, acute respiratory failure, high flow therapy with nasal cannulas, consensus Document downloaded from http://www.elsevier.es, day 27/09/2021. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Spanish Consensus Document on the use of Non-Invasive Respiratory Support in patients with severe Acute Respiratory Failure Relations with the industry and other conflicts. The policy by the SEPAR/SEMICYUC Boards of Directors has been to sponsor the working meetings and position and consensus documents without commercial support, and all CC and WG members volunteered. Therefore, at the end of this document, all members of the CC and WG, as well as the reviewers, have revealed any potential conflicts of interest in detail and such conflicts have been addressed by the coordination of this document. Document downloaded from http://www.elsevier.es, day 27/09/2021. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Spanish Consensus Document on the use of Non-Invasive Respiratory Support in patients with severe Acute Respiratory Failure Table of Contents Table of Contents ......................................................................................................... 3 Endorsements .............................................................................................................. 7 Authors of the Working Group ....................................................................................... 8 Summary ................................................................................................................... 11 Abstract ..................................................................................................................... 12 1. Introduction ........................................................................................................... 13 2. Justification ............................................................................................................ 15 3. Methods ................................................................................................................ 16 3.1. Definitions ....................................................................................................................................... 17 3.2. Search strategy ............................................................................................................................... 18 3.3. Agreement strategy ........................................................................................................................ 19 FIRST PART: To whom should non-invasive respiratory support be administered? ....................... 23 4. Indications for NIMV ............................................................................................... 24 4.1. Adult patients in need of urgent support prior to obtaining a definite diagnosis .......................... 24 4.2. Indication of NIMV in adult patients with a definite diagnosis ...................................................... 26 4.2.1. Acute chronic obstructive pulmonary disease (COPD) ........................................................... 26 4.2.2. Acute cardiogenic pulmonary oedema (ACPO) ....................................................................... 27 4.2.3. Respiratory decompensations in patients with Obesity-Hypoventilation Syndrome (OHS) ... 29 4.2.4. NIMV in palliative care ............................................................................................................ 29 4.2.5. Severe exacerbation of asthma (SEA) ..................................................................................... 30 4.2.6. De novo hypoxaemic respiratory failure ................................................................................. 30 4.2.7. Patients with acute respiratory failure and do-not-intubate orders ...................................... 32 4.2.8. Neuromuscular diseases ......................................................................................................... 33 3 4.2.9. Thoracic trauma ...................................................................................................................... 33 4.2.10. NIMV in weaning and extubation ......................................................................................... 34 4.2.11. NIMV in viral pandemic situations ...................................................................................... 366 Document downloaded from http://www.elsevier.es, day 27/09/2021. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Spanish Consensus Document on the use of Non-Invasive Respiratory Support in patients with severe Acute Respiratory Failure 4.2.12. Acute postoperative respiratory failure ................................................................................ 36 4.3. Indications for NIMV in paediatric patients .................................................................................... 37 4.3.1. General ARF (hypoxaemia with hypercapnia) and reintubation prevention .......................... 37 4.3.2. Hypoxemic ARF without hypercapnia ..................................................................................... 38 4.3.3. Paediatric patients with ARF in the context of severe asthma attacks ................................... 39 4.3.4. Miscellaneous ......................................................................................................................... 40 4.4. Indications for NIMV in neonatology .............................................................................................. 41 4.4.1. Initial stabilisation after birth ................................................................................................. 41 4.4.2. Respiratory Distress Syndrome (pathology of prematurity due to surfactant deficiency) ..... 41 4.4.3. Preventing ARF after extubation ........................................................................................... 411 4.4.4. Other neonatal respiratory pathologies ................................................................................. 42 4.4.5. Extrarespiratory causes ........................................................................................................... 42 5. Indications for high-flow nasal cannula therapy .......................................................... 43 5.1. Indications for HFNCT in adults ...................................................................................................... 43 5.1.1. ARF in pneumonia and acute respiratory distress syndrome ................................................ 43 5.1.2. ARF in immunosuppressed patients ....................................................................................... 44 5.1.3. Preventing respiratory failure and reintubation after extubation .......................................... 44 5.1.4 Pre-oxygenation prior to intubation ........................................................................................ 46 5.1.5 Miscellaneous .......................................................................................................................... 47 5.2. Indications for HFNCT in paediatric patients .................................................................................. 48 5.3. Indications for HFNCT in neonatology ............................................................................................ 50 6. Considerations specific to the use of NIMV in the pre-hospital environment .................. 51 7. Contraindications to non-invasive respiratory support..................................................... 52 SECOND PART: HOW TO PERFORM NON-INVASIVE RESPIRATORY SUPPORT? ................................... 54 8. Risk stratification ............................................................................................................. 55 9. Physical environment and staffing ................................................................................... 57 9.1. Particularities of application in a pre-hospital environment .......................................................... 57 9.2. Hospital units for adult patients ..................................................................................................... 57 9.3. Paediatric units ............................................................................................................................... 59 9.4. Neonatal units ................................................................................................................................ 59 10. Material and technology requirements .......................................................................... 60 Document downloaded from http://www.elsevier.es, day 27/09/2021. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Spanish Consensus Document on the use of Non-Invasive Respiratory Support in
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