Non-invasive ventilation: established and expanding roles

Abstract

-Non-invasive ventilation (NIV) has become the standard of care for most patients with ventilatory failure due to an acute exacerbation of chronic obstructive pulmonary disease (COPD). In all but a small minority, even of the very sickest, there is little to be lost by at least a short trial of NIV. In patients with acute cardiogenic pulmonary oedema, NIV results in a more rapid physiological improvement and resolution of dyspnoea, but the benefits in terms of survival have been called into question by two recent randomised controlled trials. There are no randomised controlled trials of NIV in patients with acute ventilatory failure due to obesity but the outcome from invasive ventilation is poor and the results of NIV encouraging. Finally, NIV may have a role during the transition from active care, aimed to extend life, to palliative care.KEY WORDS: chronic obstructive pulmonary disease (COPD), cardiogenic pulmonary oedema, respiratory failure, obesity, palliative care

Acute pulmonary oedema in pregnant women

“…Despite the risks of aspiration [82], non‐invasive ventilation should be tried as the initial technique before tracheal intubation, as it provides increased inspired oxygen concentration, displaces fluid from the alveoli into the pulmonary and subsequently systemic circulation, decreases the work of breathing, and decreases the need for tracheal intubation [31, 83] (level 1++ evidence). The use of non‐invasive ventilation also avoids the complications associated with tracheal intubation in pregnant or recently pregnant women who are hypertensive, such as intracerebral haemorrhage [83, 84]. Mechanical ventilation strategies incorporating the known cardiorespiratory and metabolic changes of pregnancy need to be considered when ventilating the lungs of a pregnant or recently pregnant woman, as well as the lung protective strategies of low tidal volumes and low peak pressures [38].…”

Acute Respiratory Failure

“…In a study conducted by Jain et al 23 in 2015, among 2320 cases diagnosed with CAP, no identifiable pathogen could be identified even in the advancement of diagnostic studies, 65% of the cases. 8 As such, this has been posted as one of the significant difficulties in managing pneumonia, pushing clinicians to treat patients empirically. However, finding the etiological agent is still essential to promote antimicrobial stewardship, limiting the adverse events and reducing cost, antimicrobial resistance, and Clostridioides difficile events.…”

“…The development of acute hypercapnia with significant refractory acidemia (eg, pH <7.2) accompanied by a marked depression in the level of consciousness is usually an indication for intubation and mechanical ventilation 8…”

Renal and cardiovascular repercussions in preeclampsia and their impact on fluid management: a literature review

“…Regarding ventilatory support, noninvasive modalities are initially preferred due to the risks associated with tracheal intubation in hypertensive pregnant women, such as intracerebral hemorrhage. 10 , 71 , 72…”