- •
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
Noninvasive Ventilation
Section snippets
Key points
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
References (76)
- et al.
Non-invasive ventilation in acute respiratory failure
Lancet
(2009) - et al.
Utilization of noninvasive ventilation in acute care hospitals: a regional survey
Chest
(2006) - et al.
Early use of noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicenter randomized controlled trial
Lancet
(2000) - et al.
Randomized controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease
Lancet
(1993) - et al.
Comparison of noninvasive positive pressure ventilation with standard medical therapy in hypercapnic acute respiratory failure
Chest
(1998) - et al.
Noninvasive positive-pressure ventilation to treathypercapnic coma secondary to respiratoryfailure
Chest
(2005) - et al.
Patient-ventilator asynchrony during noninvasive ventilation: a bench and clinical study
Chest
(2012) - et al.
Nasal high-flow therapy delivers low level positive airway pressure
Br J Anaesth
(2009) - et al.
Noninvasive positive-pressure ventilation via face mask during bronchoscopy with BAL in high-risk hypoxemic patients
Chest
(1996) - et al.
Noninvasive positive-pressure ventilation vs. conventional oxygen supplementation in hypoxemic patients undergoing diagnostic bronchoscopy
Chest
(2002)
Efficacy and safety of early dexmedetomidine during noninvasive ventilation forpatients with acute respiratory failure: a randomized, double-blind, placebo-controlled pilot study
Chest
Complications of acute respiratory failure
Am Rev Respir Dis
Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting
CMAJ
Noninvasive mechanical ventilation in acute respiratory failure: trends in use and outcomes
Intensive Care Med
Changing use of noninvasive ventilation in critically ill patients: trends over 15 years in francophone countries
Intensive Care Med
Physiologic effects of positive end-expiratory pressure and mask pressure support during exacerbations of chronic obstructive pulmonary disease
Am J Respir Crit Care Med
Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease
N Engl J Med
Randomized, prospective trial of noninvasive positive pressure ventilation in acute respiratory failure
Am J Respir Crit Care Med
Outcomes associated with invasive and noninvasive ventilation among patients hospitalized with exacerbations of chronic obstructive pulmonary disease
JAMA Intern Med
Randomised controlled comparison of continuous positive airways pressure, bilevel non-invasive ventilation, and standard treatment in emergency department in patients with acute cardiogenic pulmonary oedema
Emerg Med J
Noninvasive pressure support ventilation vs. continuous positive airway pressure in acute hypercapnic pulmonary edema
Intensive Care Med
Noninvasiveventilation in acute cardiogenicpulmonary edema
N Engl J Med
The use of noninvasive ventilation in emergency department patients with acute cardiogenic pulmonary edema: a systematic review
Ann Emerg Med
Noninvasive ventilation in acute cardiogenic pulmonary edema: better than continuous positive airway pressure?
Intensive Care Med
Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis
JAMA
A comparison of continuous and bi-level positive airway pressure non-invasive ventilation in patients with acute cardiogenic pulmonary oedema: a meta-analysis
Crit Care
Is helmet CPAP first line pre-hospital treatment of presumed severe acute pulmonary edema?
Intensive Care Med
A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure
N Engl J Med
A multiple-center survey on the use in clinical practice of noninvasive ventilation as a first-line intervention for acute respiratory distress syndrome
Crit Care Med
Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation
JAMA
Noninvasive mechanical ventilation for acute respiratory failure
BMJ
Predictors of noninvasive ventilation failure in patients with hematologic malignancy and acute respiratory failure
Crit Care Med
Noninvasive versus invasive ventilation for acute respiratory failure in patients with hematologic malignancies: a 5-year multicenter observational survey
Crit Care Med
Early CPAP prevents evolution of acute lung injury in patients with hematologic malignancy
Intensive Care Med
Effect of noninvasive ventilation vs oxygen therapy on mortality among immunocompromised patients with acute respiratory failure: a randomized clinical trial
JAMA
Failure of noninvasive ventilation for de novo acute hypoxemic respiratory failure: role of tidal volume
Crit Care Med
Noninvasive positive-pressure ventilation for postextubation respiratory distress: a randomized controlled trial
JAMA
Noninvasive positive-pressure ventilation for respiratory failure after extubation
N Engl J Med
Cited by (36)
Effect of different noninvasive ventilation interfaces on the prevention of facial pressure injury: A network meta-analysis
2024, Intensive and Critical Care NursingNoninvasive Ventilation and Oxygenation Strategies
2022, Surgical Clinics of North AmericaCitation Excerpt :Generally, a patient has compensatory pulmonary mechanisms in chronic COPD. The increased flow resistance impairs full expiration before the next inspiration and produces hyperinflation and use of accessory muscles.2 However, the patient's compensatory mechanism diminishes during an acute exacerbation.
Analysis of the Use of Non-Invasive Lung Ventilation Support in Newborns and Young Children after Cardiac Surgery
2023, Ukrainskyi Zhurnal Sertsevo-sudynnoi KhirurhiiA New Full-Face Mask for Multifunctional Non-Invasive Ventilation
2023, Medicina (Lithuania)Systematic rotation versus continuous application of ‘nasal prongs’ or ‘nasal mask’ in preterm infants on nCPAP: a randomized controlled trial
2023, European Journal of Pediatrics
All authors declare no conflict of interest relevant to this article.