What are the SFAR-SRLF joint guidelines on respiratory therapy following a rapid sequence intubation?

Updated: Apr 07, 2020
  • Author: Keith A Lafferty, MD; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Answer

Suggested prophylactic measures include high-flow oxygen therapy via a nasal cannula (1) after cardiothoracic surgery, (2) after extubation in hypoxemic patients, and (3) in patients at low risk of reintubation. Additionally, noninvasive ventilation is suggested as a prophylactic measure in patients at high-risk of reintubation, especially hypercapnic patients.

Noninvasive ventilation is suggested as a therapeutic measure to treat acute postoperative respiratory failure, especially after lung resection or abdominal surgery.

Noninvasive ventilation is not suggested as treatment for acute respiratory failure after extubation in the ICU unless the patient has underlying COPD or if blatant cardiogenic pulmonary edema is present.

For pediatric patients, noninvasive ventilation is not recommended in low-risk patients.

Physiotherapist treatment is likely required before and after endotracheal extubation following mechanical ventilation for more than 48 hours to reduce weaning duration and risk of extubation failure. A physiotherapist also should probably attend endotracheal extubation; this may help limit immediate complications (eg, bronchial obstruction in patients at high risk for extubation failure).


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