Alternatives to Invasive Ventilation in the COVID-19 Pandemic | Critical Care Medicine | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

Alternatives to Invasive Ventilation in the COVID-19 Pandemic

Educational Objective
To understand the alternatives to invasive ventilation
1 Credit CME

Since its invention in the 1940s, the positive pressure ventilator has always been known to have both risks and benefits. Although mechanical ventilation is unquestionably lifesaving, there are numerous associated drawbacks. Beyond the obvious and immediate limitations that patients require translaryngeal intubation and are physically attached to a ventilator, delivery of gas by positive pressure also creates mechanical stress and causes strain on lung tissue. This stress can lead to ventilator-induced lung injury, compounding the underlying lung condition that precipitated the initial respiratory failure.1 Despite advances in knowledge about protective ventilation strategies to limit ventilator-induced lung injury (most notably use of low tidal volumes), concern remains for this iatrogenic injury in all patients undergoing intubation and mechanical ventilation.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

Article Information

Corresponding Author: Jesse B. Hall, MD, Pritzker School of Medicine, Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, 5841 S Maryland Ave, MC 6026, Chicago, IL 60637 (jhall@medicine.bsd.uchicago.edu).

Published Online: June 4, 2020. doi:10.1001/jama.2020.9611

Conflict of Interest Disclosures: Dr Patel reported receipt of grants from the Parker B. Francis Foundation outside the submitted work. No other disclosures were reported.

References
1.
Marini  JJ , Rocco  PRM , Gattinoni  L .  Static and dynamic contributors to ventilator-induced lung injury in clinical practice. pressure, energy, and power.   Am J Respir Crit Care Med. 2020;201(7):767-774. doi:10.1164/rccm.201908-1545CIPubMedGoogle ScholarCrossref
2.
Hilbert  G , Gruson  D , Vargas  F ,  et al.  Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure.   N Engl J Med. 2001;344(7):481-487. doi:10.1056/NEJM200102153440703PubMedGoogle ScholarCrossref
3.
Antonelli  M , Conti  G , Bufi  M ,  et al.  Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial.   JAMA. 2000;283(2):235-241. doi:10.1001/jama.283.2.235PubMedGoogle ScholarCrossref
4.
Lemiale  V , Mokart  D , Resche-Rigon  M ,  et al; Groupe de Recherche en Réanimation Respiratoire du patient d’Onco-Hématologie.  Effect of noninvasive ventilation vs oxygen therapy on mortality among immunocompromised patients with acute respiratory failure: a randomized clinical trial.   JAMA. 2015;314(16):1711-1719. doi:10.1001/jama.2015.12402PubMedGoogle ScholarCrossref
5.
Azoulay  E , Lemiale  V , Mokart  D ,  et al.  Effect of high-flow nasal oxygen vs standard oxygen on 28-day mortality in immunocompromised patients with acute respiratory failure: the HIGH randomized clinical trial.   JAMA. 2018;320(20):2099-2107. doi:10.1001/jama.2018.14282PubMedGoogle ScholarCrossref
6.
Brochard  L , Slutsky  A , Pesenti  A .  Mechanical ventilation to minimize progression of lung injury in acute respiratory failure.   Am J Respir Crit Care Med. 2017;195(4):438-442. doi:10.1164/rccm.201605-1081CPPubMedGoogle ScholarCrossref
7.
Richardson  S , Hirsch  JS , Narasimhan  M ,  et al; Northwell COVID-19 Research Consortium.  Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area.   JAMA. 2020;323(20):2052-2059. doi:10.1001/jama.2020.6775PubMedGoogle ScholarCrossref
8.
Ferreyro  BL , Angriman  F , Munshi  L ,  et al.  Association of noninvasive oxygenation strategies with all-cause mortality in adults with acute hypoxemic respiratory failure: a systematic review and meta-analysis.   JAMA. Published online June 4, 2020. doi:10.1001/jama.2020.9524Google Scholar
9.
Patel  BK , Wolfe  KS , Pohlman  AS , Hall  JB , Kress  JP .  Effect of noninvasive ventilation delivered by helmet vs face mask on the rate of endotracheal intubation in patients with acute respiratory distress syndrome: a randomized clinical trial.   JAMA. 2016;315(22):2435-2441. doi:10.1001/jama.2016.6338PubMedGoogle ScholarCrossref
10.
Frat  JP , Ragot  S , Thille  AW .  High-flow nasal cannula oxygen in respiratory failure.   N Engl J Med. 2015;373(14):1374-1375.PubMedGoogle Scholar
11.
Bellani  G , Laffey  JG , Pham  T ,  et al; LUNG SAFE Investigators; ESICM Trials Group.  Noninvasive ventilation of patients with acute respiratory distress syndrome. insights from the LUNG SAFE study.   Am J Respir Crit Care Med. 2017;195(1):67-77. doi:10.1164/rccm.201606-1306OCPubMedGoogle ScholarCrossref
12.
L’Her  E , Deye  N , Lellouche  F ,  et al.  Physiologic effects of noninvasive ventilation during acute lung injury.   Am J Respir Crit Care Med. 2005;172(9):1112-1118. doi:10.1164/rccm.200402-226OCPubMedGoogle ScholarCrossref
13.
Grieco  DL , Menga  LS , Raggi  V ,  et al.  Physiological comparison of high-flow nasal cannula and helmet noninvasive ventilation in acute hypoxemic respiratory failure.   Am J Respir Crit Care Med. 2020;201(3):303-312. doi:10.1164/rccm.201904-0841OCPubMedGoogle ScholarCrossref
14.
Morais  CCA , Koyama  Y , Yoshida  T ,  et al.  High positive end-expiratory pressure renders spontaneous effort noninjurious.   Am J Respir Crit Care Med. 2018;197(10):1285-1296. doi:10.1164/rccm.201706-1244OCPubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close