Personalized Noninvasive Respiratory Support in the Perioperative Setting: State of the Art and Future Perspectives
<b>Background:</b> Noninvasive respiratory support (NRS), including high-flow nasal oxygen therapy (HFNOT), noninvasive ventilation (NIV) and continuous positive airway pressure (CPAP), are routinely used in the perioperative period. <b>Objectives</b>: This narrative review p...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-12-01
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| Series: | Journal of Personalized Medicine |
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| Online Access: | https://www.mdpi.com/2075-4426/14/1/56 |
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| author | Giovanni Misseri Luciano Frassanito Rachele Simonte Tommaso Rosà Domenico Luca Grieco Alessandra Piersanti Edoardo De Robertis Cesare Gregoretti |
| author_facet | Giovanni Misseri Luciano Frassanito Rachele Simonte Tommaso Rosà Domenico Luca Grieco Alessandra Piersanti Edoardo De Robertis Cesare Gregoretti |
| author_sort | Giovanni Misseri |
| collection | DOAJ |
| description | <b>Background:</b> Noninvasive respiratory support (NRS), including high-flow nasal oxygen therapy (HFNOT), noninvasive ventilation (NIV) and continuous positive airway pressure (CPAP), are routinely used in the perioperative period. <b>Objectives</b>: This narrative review provides an overview on the perioperative use of NRS. Preoperative, intraoperative, and postoperative respiratory support is discussed, along with potential future areas of research. <b>Results</b>: During induction of anesthesia, in selected patients at high risk of difficult intubation, NIV is associated with improved gas exchange and reduced risk of postoperative respiratory complications. HFNOT demonstrated an improvement in oxygenation. Evidence on the intraoperative use of NRS is limited. Compared with conventional oxygenation, HFNOT is associated with a reduced risk of hypoxemia during procedural sedation, and recent data indicate a possible role for HFNOT for intraoperative apneic oxygenation in specific surgical contexts. After extubation, “preemptive” NIV and HFNOT in unselected cohorts do not affect clinical outcome. Postoperative “curative” NIV in high-risk patients and among those exhibiting signs of respiratory failure can reduce reintubation rate, especially after abdominal surgery. Data on postoperative “curative” HFNOT are limited. <b>Conclusions</b>: There is increasing evidence on the perioperative use of NRS. Use of NRS should be tailored based on the patient’s specific characteristics and type of surgery, aimed at a personalized cost-effective approach. |
| first_indexed | 2024-03-08T10:45:08Z |
| format | Article |
| id | doaj.art-3dc7ed0c7c20475f8ef3e39da47d00f0 |
| institution | Directory Open Access Journal |
| issn | 2075-4426 |
| language | English |
| last_indexed | 2024-03-08T10:45:08Z |
| publishDate | 2023-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Personalized Medicine |
| spelling | doaj.art-3dc7ed0c7c20475f8ef3e39da47d00f02024-01-26T17:19:25ZengMDPI AGJournal of Personalized Medicine2075-44262023-12-011415610.3390/jpm14010056Personalized Noninvasive Respiratory Support in the Perioperative Setting: State of the Art and Future PerspectivesGiovanni Misseri0Luciano Frassanito1Rachele Simonte2Tommaso Rosà3Domenico Luca Grieco4Alessandra Piersanti5Edoardo De Robertis6Cesare Gregoretti7Fondazione Istituto “G. Giglio” Cefalù, 90015 Palermo, ItalyDepartment of Emergency, Intensive Care Medicine and Anaesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00165 Rome, ItalyDepartment of Medicine and Surgery, University of Perugia, 06123 Perugia, ItalyDepartment of Emergency, Intensive Care Medicine and Anaesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00165 Rome, ItalyDepartment of Emergency, Intensive Care Medicine and Anaesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00165 Rome, ItalyDepartment of Emergency, Intensive Care Medicine and Anaesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00165 Rome, ItalyDepartment of Medicine and Surgery, University of Perugia, 06123 Perugia, ItalyFondazione Istituto “G. Giglio” Cefalù, 90015 Palermo, Italy<b>Background:</b> Noninvasive respiratory support (NRS), including high-flow nasal oxygen therapy (HFNOT), noninvasive ventilation (NIV) and continuous positive airway pressure (CPAP), are routinely used in the perioperative period. <b>Objectives</b>: This narrative review provides an overview on the perioperative use of NRS. Preoperative, intraoperative, and postoperative respiratory support is discussed, along with potential future areas of research. <b>Results</b>: During induction of anesthesia, in selected patients at high risk of difficult intubation, NIV is associated with improved gas exchange and reduced risk of postoperative respiratory complications. HFNOT demonstrated an improvement in oxygenation. Evidence on the intraoperative use of NRS is limited. Compared with conventional oxygenation, HFNOT is associated with a reduced risk of hypoxemia during procedural sedation, and recent data indicate a possible role for HFNOT for intraoperative apneic oxygenation in specific surgical contexts. After extubation, “preemptive” NIV and HFNOT in unselected cohorts do not affect clinical outcome. Postoperative “curative” NIV in high-risk patients and among those exhibiting signs of respiratory failure can reduce reintubation rate, especially after abdominal surgery. Data on postoperative “curative” HFNOT are limited. <b>Conclusions</b>: There is increasing evidence on the perioperative use of NRS. Use of NRS should be tailored based on the patient’s specific characteristics and type of surgery, aimed at a personalized cost-effective approach.https://www.mdpi.com/2075-4426/14/1/56CPAPHFNOTICUmechanical ventilationnoninvasive respiratory support (NRS)noninvasive ventilation (NIV) |
| spellingShingle | Giovanni Misseri Luciano Frassanito Rachele Simonte Tommaso Rosà Domenico Luca Grieco Alessandra Piersanti Edoardo De Robertis Cesare Gregoretti Personalized Noninvasive Respiratory Support in the Perioperative Setting: State of the Art and Future Perspectives Journal of Personalized Medicine CPAP HFNOT ICU mechanical ventilation noninvasive respiratory support (NRS) noninvasive ventilation (NIV) |
| title | Personalized Noninvasive Respiratory Support in the Perioperative Setting: State of the Art and Future Perspectives |
| title_full | Personalized Noninvasive Respiratory Support in the Perioperative Setting: State of the Art and Future Perspectives |
| title_fullStr | Personalized Noninvasive Respiratory Support in the Perioperative Setting: State of the Art and Future Perspectives |
| title_full_unstemmed | Personalized Noninvasive Respiratory Support in the Perioperative Setting: State of the Art and Future Perspectives |
| title_short | Personalized Noninvasive Respiratory Support in the Perioperative Setting: State of the Art and Future Perspectives |
| title_sort | personalized noninvasive respiratory support in the perioperative setting state of the art and future perspectives |
| topic | CPAP HFNOT ICU mechanical ventilation noninvasive respiratory support (NRS) noninvasive ventilation (NIV) |
| url | https://www.mdpi.com/2075-4426/14/1/56 |
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