Introduction: The benefits of noninvasive ventilation (NIV) is debated in hypoxemic ARF, and has never been studied in acute exacerbation of interstitial lung disease (AE-ILD). The potential protective effects of high-flow nasal cannula oxygen therapy (HFNC) deserve to be evaluated in this condition. Aims and Objectives: To compare the outcome of AE-ILD according to their oxygenation strategy used during the first 24 hours following their intensive care unit (ICU) admission : HFNC or NIV associated with HFNC or not. Methods: We conducted a multicenter retrospective study in 4 French tertiary hospitals between 2010 and 2020. The primary outcome was in-hospital mortality between the groups. Results: Among 3962 screened patients, 163 were included. 31.3% of AE-ILD were inaugural. 118 in the HFNC group and 45 in the NIV ± HFNC group. During the study period, the rate of HFNC use increased from 50% to 88.2%. The in-hospital mortality rate was not significantly different between both groups: 45.9% in the HFNC group vs 55.2% in the NIV ± HFNC group (p=0.39). The intubation rate was 25.6% and 36.9% in the HFNC vs NIV ± HFNC group, respectively (p=0.25). No independant prognostic factor was identified for both groups in multivariate analysis. Conclusion: Management of AE-ILD has progressively include HFNC use during the past 10 years, despite the lack of evidence in the literature. Our study did not find any superiority of NIV ± HFNC vs HFNC alone in AE-ILD outcome but deserve further research with more patients.

The current gold-standard treatment for COVID-19-related hypoxemic respiratory failure is invasive mechanical ventilation. However, do not intubate orders (DNI), prevent the use of this treatment in some cases. The aim of this study was to evaluate if non-invasive ventilatory supports can provide a good therapeutic alternative to invasive ventilation in patients with severe COVID-19 infection and a DNI. Data were collected from four centres in three European countries. Patients with severe COVID-19 infection were included. We emulated a hypothetical target trial in which outcomes were compared in patients with a DNI order treated exclusively by non-invasive respiratory support with patients who could be intubated if necessary. We set up a propensity score and an inverse probability of treatment weighting to remove confounding by indication. Four-hundred patients were included: 270 were eligible for intubation and 130 had a DNI order. The adjusted risk ratio for death among patients eligible for intubation was 0.81 (95% CI 0.46 to 1.42). The median length of stay in acute care for survivors was similar between groups (18 (10–31) vs. (19 (13–23.5); p = 0.76). The use of non-invasive respiratory support is a good compromise for patients with severe COVID-19 and a do not intubate order.

Background: In patients with obesity hypoventilation syndrome (OHS), current monitoring of domiciliary non-invasive ventilation (NIV) relies on clinical outcomes, daytime arterial blood gases (ABG) and nocturnal pulse oximetry. Aim: To evaluate the usefulness of nocturnal transcutaneous capnography in assessing nocturnal hypoventilation when compared to routine exams. Methods: A monocentric prospective study was conducted from August 2018 to November 2019 in a university hospital centre in France. Thirty-two patients suffering from OHS treated with domiciliary NIV were included. Systematic nocturnal transcutaneous capnography was performed after at least 6 months of home ventilation. Results: Twenty-nine transcutaneous capnographies were analyzed. Main results are displayed in the Table. Eighteen tests showed nocturnal hypoventilation, even though the combination of ABG and nocturnal pulse oximetry revealed nocturnal hypoventilation in 9 cases only. Among the 19 patients with normal ABG and nocturnal pulse oximetry, 11 exhibited nocturnal hypoventilation on transcutaneous capnography. Only one patient reported symptoms. Conclusion: Based on these findings, we suggest that patients with OHS treated by home NIV should be systematically evaluated with additional transcutaneous capnography to detect nocturnal hypoventilation.

CASE PRESENTATION:This clinical case presents the history of a woman hospitalized for acute respiratory distress syndrome (ARDS). A 62-year-old woman, with regular physical activity and no history of respiratory disease or smoking, was hospitalized for moderate ARDS with bilateral pneumonitis. Fourteen days later, she was discharged from the intensive care unit and received respiratory physical therapy. One month later, she experienced exertional dyspnea. A regression of alveolar condensation with persistent sequelae at the pulmonary bases was noted. Three months later, the patient continued daily physical activity with satisfactory tolerance. A reduction in alveolar-capillary transfer, inappropriate hyperventilation upon exercise, and impairment of gas exchanges at maximal effort, suggestive of pulmonary shunt, were demonstrated. At the 6-month evaluation, the patient displayed exertional dyspnea with residual bilateral basal consolidations. Six months later, the dyspnea had ceased. The persistence of bilateral basal interstitial syndrome associated with bronchial dilatation and pleural-based consolidations was noted, as well as a stable impaired alveolar-capillary diffusing capacity.DISCUSSION:Upon discharge from intensive care, pulmonary follow-up should be proposed to ARDS survivors. Moreover, pulmonary function testing at rest and exercise is advised as soon as possible to evaluate the respiratory sequelae. This will help to limit the severity of complications through adapted exercise rehabilitation and then regular physical activity.