Noninvasive respiratory support in the hypoxaemic peri-operative/periprocedural patient: a joint ESA/ESICM guideline

Abstract

Hypoxaemia is a potential life-threatening yet common complication in the peri-operative and periprocedural patient (e.g. during an invasive procedure at risk of deterioration of gas exchange, such as bronchoscopy). The European Society of Anaesthesiology (ESA) and the European Society of Intensive Care Medicine (ESICM) developed guidelines for the use of noninvasive respiratory support techniques in the hypoxaemic patient in the peri-operative and periprocedural period. The panel outlined five clinical questions regarding treatment with noninvasive respiratory support techniques [conventional oxygen therapy (COT), high flow nasal cannula, noninvasive positive pressure ventilation (NIPPV) and continuous positive airway pressure (CPAP)] for hypoxaemic patients with acute peri-operative/periprocedural respiratory failure. The goal was to assess the available literature on the various noninvasive respiratory support techniques, specifically studies that included adult participants with hypoxaemia in the peri-operative/periprocedural period. The literature search strategy was developed by a Cochrane Anaesthesia and Intensive Care trial search specialist in close collaboration with the panel members and the ESA group methodologist. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the level of evidence and to grade recommendations. The final process was then validated by both ESA and ESICM scientific committees. Among 19 recommendations, the two grade 1B recommendations state that: in the peri-operative/periprocedural hypoxaemic patient, the use of either NIPPV or CPAP (based on local expertise) is preferred to COT for improvement of oxygenation; and that the panel suggests using NIPPV or CPAP immediately post-extubation for hypoxaemic patients at risk of developing acute respiratory failure after abdominal surgery.

Keywords: Hypoxaemia; Peri-operative; Periprocedural; Ventilation.

Conflict of interest statement

ML received personal fees for lecture from MSD, Pfizer, Orion, Octapharma, Aspen, and for consulting from Aguettant and Amomed (all these activities were outside the submitted work); SE received travel fees from Medtechnica, Laerdal, Zoll and Diasorin (all these activities were outside the submitted work); JMC received personal fees and non-financial support from Dräger, GE Healthcare, Fisher and Paykel Philips Medical Healthcare, and Bird Corporation (all these activities related to the work under consideration); JMC also received personal fees and non-financial support from Sedana Medical, Baxter, Amomed, Orion, Fresenius Medical Care and LFB (all these activities were outside the submitted work); EDR received personal fees from Medtronic, Masimo and MSD for lecture and from Aguettant for consulting (all these activities were outside the submitted work); MGDA received grant and personal fees from GE Healthcare, GSK and Dräger Medical (all these activities were outside the submitted work); CG received personal fees from ResMed, Philips and Fisher & Paykel; (all these activities were outside the submitted work); SJ received personal fees as consultant from Dräger, Fisher-Paykel, Fresenius-Xenios, Medtronic and Baxter (all these activities were in relation with the work under consideration); SMM received personal fees from Drager Medical, GE Healthcare, and Fisher & Paykel Healthcare (all these activities were outside the submitted work); MS received personal fees and non-financial support from Teleflex Medical, MSD and DEAS (all these activities were outside the submitted work); LB, none; DC, none; SC, none; AC, none; SF: none; YH, none; JM, none; PP, none; GMR, none; AA, none; BP, none; MH, none; JW, none; PDG, none; LG, none; MS, none.