No new drug approvals or safety communications affecting respiratory practice today.
The American Thoracic Society has issued an official clinical practice guideline on non-invasive respiratory support for adults with acute respiratory failure — the territory covering high-flow nasal oxygen, continuous positive airway pressure and non-invasive ventilation, and when each is the right choice.
This is contested ground where practice has moved faster than evidence. High-flow nasal oxygen in particular spread through emergency departments and wards on the strength of tolerability and a small number of trials, and the boundary between a patient who should have it and one who should be intubated is where most of the harm sits — delayed intubation being the recognised risk of any non-invasive strategy that is working almost well enough.
An official society guideline in this area is worth reading in full rather than in summary, because the useful content is in which patient groups the recommendations distinguish and how strongly each is graded.
- No new approvals, recalls or safety communications for respiratory medicine today
- Covers high-flow nasal oxygen, CPAP and non-invasive ventilation together
- The clinical risk is delayed intubation, not the modality itself
- Practice in this area has outpaced the trial evidence for several years
- Read the strength of each recommendation, not only its direction
The statistics, in plain English
Guidelines grade both the certainty of evidence and the strength of the recommendation, and the two come apart more often than readers expect: a strong recommendation can rest on low-certainty evidence when the alternative is clearly worse. Reading only the recommendation and not its grade is how guidance gets applied more confidently than its authors intended.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for pulmonology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free