Elsevier

Clinics in Chest Medicine

Volume 37, Issue 4, December 2016, Pages 711-721
Clinics in Chest Medicine

Noninvasive Ventilation

https://doi.org/10.1016/j.ccm.2016.07.011Get rights and content

Section snippets

Key points

  • Noninvasive ventilation (NIV) is widely used to treat critically ill patients with acute respiratory failure (ARF) of various origins, in particular those with chronic obstructive pulmonary disease (COPD) exacerbation or acute cardiogenic pulmonary edema (CPE) or who are immunocompromised.

  • Identifying patients who are proper candidates for NIV and those in whom NIV is not likely to be effective can help avoid inappropriate NIV application or unnecessary delays before starting invasive

Chronic obstructive pulmonary disease

There is a general agreement concerning the early use of NIV in patients with ARF resulting from acute exacerbation of COPDs. In COPD patients, the increased flow resistance, and the impossibility of completing the expiration before inspiration determine high levels of dynamic hyperinflation and substantial shortening of the diaphragm and the inspiratory intercostals and accessory muscles, thereby reducing mechanical efficiency and endurance. The need to overcome the inspiratory threshold load

Which Interface

Interfaces are devices that connect ventilator tubing to the face, allowing the delivery of pressurized gas into the airway during NIV. Currently available interfaces include nasal and oronasal masks, helmets, and mouthpieces. Selection of a comfortable interface that fits properly is of paramount importance for the success of NIV (Fig. 2). In the acute setting, oronasal masks are preferable to nasal masks because dyspneic patients are mouth breathers, predisposing to greater air leakage during

High-flow Nasal Cannula

High-flow nasal cannula (HFNC) is increasingly used in critically ill patients. Compared with traditional nasal cannula and face mask oxygen, its use provides an increased level of respiratory support, potentially reducing the work of breathing. HFNC benefits are mainly based on the maintenance of constant Fio2, the increase of CO2 clearance through nasopharyngeal dead space washout, and the generation of a modest degree of positive distending pressure.58 Although during HFNC, at a flow rate of

Summary

Current evidence indicates clear benefits of NIV in the treatment of critically ill patients with ARF of various origins, in particular those with acute-on-chronic ARF, or CPE, or who are immunocompromised. Identification of predictors of success or failure may help in recognizing patients who are likely to benefit from NIV and exclude those for whom NIV would be unsafe or ineffective, avoiding dangerous delays before ETI. Patients at high risk of NIV failure should be managed only by

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