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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

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martes, 13 de febrero de 2018

BiPAP & HFNC

PulmCrit (EMCrit)
PulmCrit - February 12, 2018 - By Josh Farkas 
"Skillful use of BiPAP and high-flow nasal cannula (HFNC) can avoid intubation and improve outcomes. However, there isn't comprehensive evidence about the nitty-gritty details of these techniques. In this post I will use my opinions to fill some gaps in the evidence (1). Noninvasive respiratory support remains more of an art than a science, perhaps a dark art at that...

  • The role of noninvasive respiratory support is generally to reduce the patient's work of breathing, thereby avoiding diaphragmatic exhaustion.
  • The goal of noninvasive respiratory support isn't to immediately normalize the ABG.
  • Serial evaluation by experienced practitioners is generally far more useful than monitoring ABG values.
  • The choice of BiPAP vs. HFNC may be made on the basis of the patient's diagnosis (e.g. pneumonia vs. heart failure), not the ABG values.
  • BiPAP should never be used to “blow off” CO2 in a patient with hypoventilation due to drug intoxication."