Case Report: Prone Positioning and Nasal High Flow Oxygen Therapy - An Alternative Strategy to Invasive and Non-Invasive Ventilation in a Case of Severe Acute Respiratory Distress Syndrome

Acute respiratory distress syndrome (ARDS) is associated with high rates of mortality, which is directly attributed to the pulmonary inflammatory response then compromising gaseous exchange. This case study describes the successful management of a 63-year-old male with severe ARDS who received a strategy which involved the following interventions: Nasal High Flow Oxygen (NHFO) therapy, and prone positioning. It is thought that this strategy improved the lung volume at end expiration to an extent that the patient was able to avoid both noninvasive (NIV) and invasive mechanical ventilation (MV) (and their known associated risks). There is limited evidence describing the use of NHF therapy in patients with ARDS. The use of prone positioning has been demonstrated to significantly improve 28-day mortality in patients with severe ARDS with a PaO2/FiO2< 150 mmHg. The authors acknowledge that until such time that controlled clinical trials considering the efficacy of strategy are conducted it would be premature to recommend it forall suchcases. The prone position is a promising therapy for patients with spontaneous ventilation with high-flow oxygen therapy; controlled and randomized studies should be done to demonstrate its safety and efficacy

Hemodynamic and respiratory support in pulmonary embolism: a narrative review

Pulmonary embolism is a common and potentially fatal disease, with a significant burden on health and survival. Right ventricular dysfunction and hemodynamic instability are considered two key determinants of mortality in pulmonary embolism, which can reach up to 65% in severe cases. Therefore, timely diagnosis and management are of paramount importance to ensure the best quality of care. However, hemodynamic and respiratory support, both major constituents of management in pulmonary embolism, associated with cardiogenic shock or cardiac arrest, have been given little attention in recent years, in favor of other novel advances such as systemic thrombolysis or direct oral anticoagulants. Moreover, it has been implied that current recommendations regarding this supportive care lack enough robustness, further complicating the problem. In this review, we critically discuss and summarize the current literature concerning the hemodynamic and respiratory support in pulmonary embolism, including fluid therapy, diuretics, pharmacological support with vasopressors, inotropes and vasodilators, oxygen therapy and ventilation, and mechanical circulatory support with veno-arterial extracorporeal membrane oxygenation and right ventricular assist devices, while also providing some insights into contemporary research gaps