Nasal Mask Ventilation in Acute Respiratory Failure

Use of noninvasive ventilation on internal wards for elderly patients with limitations to respiratory care: a cohort study

“…The refusal of endotracheal intubation and ICU admission is more likely to occur in this patient subset. In this age group, acute exacerbations of COPD have been successfully treated with NPPV [15,20,21], and the available data suggest a benefit of NPPV use in patients with CPE, pneumonia, or DNI [22]. In our series, only a few variables were related to mortality.…”

“…Observational studies have previously examined the potential benefit of NPPV in patients with DNI orders based on patients' wishes [6,8,9,[11][12][13][14][15]. Evidence supporting this indication is weak, but a trend towards reduced in-hospital mortality may be present [19].…”

“…A recent article summarized the evidence to support the use of NPPV in DNI patients [8]. Uncontrolled observational studies suggest a benefit in cases of patient-based DNI decisions [9][10][11][12][13][14] and in cases of elderly or end-stage chronic patients with NPPV as the ceiling of ventilator care [15]. These studies report short-term and, eventually, long-term mortality rates [11,14].…”

Advanced Chronic Obstructive Pulmonary Disease: Innovative Approaches to Palliation

“…Two early, small case series reported that NIV can reduce dyspnea and preserve patient autonomy in appropriately selected patients who declined invasive ventilatory support. 122,123 Recently, there has been resurgence in the interest in assessing the effectiveness of NIV for patients who have declined mechanical ventilation. Examples of these patients include patients with advanced COPD at home or in hospice settings who develop acute respiratory failure requiring hospital admission or in patients on palliative care floors of acute care hospitals.…”

Noninvasive Ventilation

“…Volume-cycled noninvasive ventilation, in which the ventilator delivers a set volume for each breath, can improve outcomes in acute respiratory failure 10,11 and has been used to manage chronic respiratory failure. [12][13][14] However, patients' tolerance of this therapy is often poor, 10,15 in part because the inspiratory pressure may be elevated, which can be uncomfortable and cause leaks.…”