TY  - JOUR
A1  - Schmid, Benedikt
A1  - Griesel, Mirko
A1  - Fischer, Anna-Lena
A1  - Romero, Carolina S.
A1  - Metzendorf, Maria-Inti
A1  - Weibel, Stephanie
A1  - Fichtner, Falk
T1  - Awake prone positioning, high-flow nasal oxygen and non-invasive ventilation as non-invasive respiratory strategies in COVID-19 acute respiratory failure: a systematic review and meta-analysis
JF  - Journal of Clinical Medicine
N2  - Background: Acute respiratory failure is the most important organ dysfunction of COVID-19 patients. While non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC) oxygen are frequently used, efficacy and safety remain uncertain. Benefits and harms of awake prone positioning (APP) in COVID-19 patients are unknown. Methods: We searched for randomized controlled trials (RCTs) comparing HFNC vs. NIV and APP vs. standard care. We meta-analyzed data for mortality, intubation rate, and safety. Results: Five RCTs (2182 patients) were identified. While it remains uncertain whether HFNC compared to NIV alters mortality (RR: 0.92, 95% CI 0.65–1.33), HFNC may increase rate of intubation or death (composite endpoint; RR 1.22, 1.03–1.45). We do not know if HFNC alters risk for harm. APP compared to standard care probably decreases intubation rate (RR 0.83, 0.71–0.96) but may have little or no effect on mortality (RR: 1.08, 0.51–2.31). Conclusions: Certainty of evidence is moderate to very low. There is no compelling evidence for either HFNC or NIV, but both carry substantial risk for harm. The use of APP probably has benefits although mortality appears unaffected.
KW  - respiratory failure
KW  - non-invasive ventilation
KW  - high-flow nasal cannula
KW  - awake prone positioning
KW  - COVID-19
KW  - systematic review
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-255225
SN  - 2077-0383
VL  - 11
IS  - 2
ER  - 
TY  - JOUR
A1  - Glaser, Kirsten
A1  - Speer, Christian P.
A1  - Wright, Clyde J.
T1  - Fine tuning non-invasive respiratory support to prevent lung injury in the extremely premature infant
JF  - Frontiers in Pediatrics
N2  - Within the last decades, therapeutic advances, such as antenatal corticosteroids, surfactant replacement, monitored administration of supplemental oxygen, and sophisticated ventilatory support have significantly improved the survival of extremely premature infants. In contrast, the incidence of some neonatal morbidities has not declined. Rates of bronchopulmonary dysplasia (BPD) remain high and have prompted neonatologists to seek effective strategies of non-invasive respiratory support in high risk infants in order to avoid harmful effects associated with invasive mechanical ventilation. There has been a stepwise replacement of invasive mechanical ventilation by early continuous positive airway pressure (CPAP) as the preferred strategy for initial stabilization and for early respiratory support of the premature infant and management of respiratory distress syndrome. However, the vast majority of high risk babies are mechanically ventilated at least once during their NICU stay. Adjunctive therapies aiming at the prevention of CPAP failure and the support of functional residual capacity have been introduced into clinical practice, including alternative techniques of administering surfactant as well as non-invasive ventilation approaches. In contrast, the strategy of applying sustained lung inflations in the delivery room has recently been abandoned due to evidence of higher rates of death within the first 48 h of life.
KW  - preterm infant
KW  - respiratory distress syndrome (RDS)
KW  - lung injury
KW  - bronchopulmonary dysplasia (BPD)
KW  - non-invasive ventilation
KW  - non-invasive respiratory support
KW  - continuous positive airway pressure (CPAP)
KW  - sustained lung inflation (SLI)
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-193762
SN  - 2296-2360
VL  - 7
ER  -