Non-invasive ventilation in acute respiratory failure

Abstract

Abstract:After the institution of positive-pressure ventilation, the use of noninvasive ventilation (NIV) through an interface substantially increased. The first technique was continuous positive airway pressure; but, after the introduction of pressure support ventilation at the end of the 20th century, this became the main modality. Both techniques, and some others that have been recently introduced and which integrate some technological innovations, have extensively demonstrated a faster improvement of acute respiratory failure in different patient populations, avoiding endotracheal intubation and facilitating the release of conventional invasive mechanical ventilation. In acute settings, NIV is currently the first-line treatment for moderate-to-severe chronic obstructive pulmonary disease exacerbation as well as for acute cardiogenic pulmonary edema and should be considered in immunocompromised patients with acute respiratory insufficiency, in difficult weaning, and in the prevention of postextubation failure. Alternatively, it can also be used in the postoperative period and in cases of pneumonia and asthma or as a palliative treatment. NIV is currently used in a wide range of acute settings, such as critical care and emergency departments, hospital wards, palliative or pediatric units, and in pre-hospital care. It is also used as a home care therapy in patients with chronic pulmonary or sleep disorders. The appropriate selection of patients and the adaptation to the technique are the keys to success. This review essentially analyzes the evidence of benefits of NIV in different populations with acute respiratory failure and describes the main modalities, new devices, and some practical aspects of the use of this technique.

Noninvasive Bilevel Positive Pressure Ventilation in Patients with Blunt Thoracic Trauma

“…This contrasts with studies showing that noninvasive bilevel positive pressure ventilation (N-BiPAP) reduces the intubation rate in a selected group of patients with acute respiratory failure [10,11,12]. On the other hand, in patients with blunt thoracic trauma, assisting the inspiratory phase with positive pressure may, theoretically, increase the risk of barotrauma and, thus, the morbidity of the disease [13]. For this reason, guidelines as far as the use of noninvasive positive pressure ventilation in this group of patients are not clear [13].…”

“…On the other hand, in patients with blunt thoracic trauma, assisting the inspiratory phase with positive pressure may, theoretically, increase the risk of barotrauma and, thus, the morbidity of the disease [13]. For this reason, guidelines as far as the use of noninvasive positive pressure ventilation in this group of patients are not clear [13]. Currently, there are no data that support or refuse this mode of therapy in patients with blunt thoracic trauma.…”

Comparison of Arterial and Venous Blood Gases and the Effects of Analysis Delay and Air Contamination on Arterial Samples in Patients with Chronic Obstructive Pulmonary Disease and Healthy Controls

“…Other studies have suggested that calculation of arterial acid-base and blood gas status can be made from measurements in the peripheral venous blood [20,21]. International guidelines for instituting non-invasive ventilation for patients with decompensated hypercapnic respiratory failure emphasize the acid-base status of a patient and the level of hypercapnia [22]. In patients with COPD exacerbation, using venous pH as a surrogate for arterial pH would be extremely useful and would spare the patient repeated ABG sampling or arterial line insertion and their potential complications.…”

Non-Invasive Pressure Support Ventilation in Patients with Respiratory Failure due to Severe Acute Cardiogenic Pulmonary Edema

“…Beneficial effects of NIPSV have also been observed on respiratory failure due to ACPE, however it remains questionable whether all patients with ACPE are candidates for NIPSV. Several trials have given conflicting results with a large inter-study variability ranging from 0 to 44% for intubation and 0 to 22% for mortality rates [10, 11, 12, 13, 14]. …”