Benefits of non‐invasive ventilation in acute hypercapnic respiratory failure

Abstract

Non‐invasive ventilation (NIV) with bilevel positive airway pressure is a non‐invasive technique, which refers to the provision of ventilatory support through the patient's upper airway using a mask or similar device. This technique is successful in correcting hypoventilation. It has become widely accepted as the standard treatment for patients with hypercapnic respiratory failure (HRF). Since the 1980s, NIV has been used in intensive care units and, after initial anecdotal reports and larger series, a number of randomized trials have been conducted. Data from these trials have shown that NIV is a valuable treatment for HRF. This review aims to explore the principal areas in which NIV can be useful, focusing particularly on patients with acute HRF (AHRF). We will update the evidence base with the goal of supporting clinical practice. We provide a practical description of the main indications for NIV in AHRF and identify the group of patients with hypercapnic failure who will benefit most from the application of NIV.

Contemporary Concise Review 2019: Sleep and ventilation

“…Non‐invasive ventilation (NIV) has proven benefits both during acute illness and for chronic disease management . The bulk of the supportive data in the chronic setting are for the treatment of hypoventilation including neuromuscular disease and chest wall disorders, hypercapnic chronic obstructive pulmonary disease (COPD) and obesity hypoventilation syndrome (OHS).…”

Comparing effectiveness of intelligent volume‐assured pressure support (iVAPS) vs bi‐level positive airway pressure spontaneous/timed (BPAP S/T) for hypercapnic respiratory failure in chronic obstructive pulmonary disease

“…Non-invasive ventilation (NIV) is currently a well-established treatment modality in the management of certain types of respiratory failure such as chronic obstructive pulmonary disease (COPD), obesity hypoventilation syndrome and neuromuscular disease that has been associated with chronic hypoventilation. [1][2][3] It can also be used for patients with acute cardiogenic pulmonary oedema, immunocompromised patients with acute respiratory failure (ARF), and patients with pneumonia or asthma. Another important area of use is for cases of difficult weaning and prevention of post-extubation failure.…”

“…Another important area of use is for cases of difficult weaning and prevention of post-extubation failure. [2][3][4][5] However, the optimal NIV mode has not been determined yet. Even though, it is considered that mode selection should be based on the underlying disease, patients' needs and tolerance.…”

Non‐invasive ventilation: A glimpse into the future

“…Significant reductions in intubation and mortality compared to standard care occur when NIV is delivered by a dedicated team in an appropriate environment . Comellini et al . provide an in‐depth, practical review of the indications for NIV in the acute setting beyond COPD, including patients with ‘do not resuscitate’ orders and those requesting palliative management only.…”

“…Significant reductions in intubation and mortality compared to standard care occur when NIV is delivered by a dedicated team in an appropriate environment. 1 Comellini et al 2 provide an indepth, practical review of the indications for NIV in the acute setting beyond COPD, including patients with 'do not resuscitate' orders and those requesting palliative management only. Appropriate patient selection is a key aspect of achieving positive outcomes, with increased hospital mortality amongst NIV users who require transition to invasive ventilation compared to those directly managed with invasive ventilation.…”