Noninvasive ventilation in acute respiratory failure: which recipe for success?

Abstract

Noninvasive positive-pressure ventilation (NPPV) to treat acute respiratory failure has expanded tremendously over the world in terms of the spectrum of diseases that can be successfully managed, the locations of its application and achievable goals.The turning point for the successful expansion of NPPV is its ability to achieve the same physiological effects as invasive mechanical ventilation with the avoidance of the life-threatening risks correlated with the use of an artificial airway.Cardiorespiratory arrest, extreme psychomotor agitation, severe haemodynamic instability, nonhypercapnic coma and multiple organ failure are absolute contraindications for NPPV. Moreover, pitfalls of NPPV reduce its rate of success; consistently, a clear plan of what to do in case of NPPV failure should be considered, especially for patients managed in unprotected setting. NPPV failure is likely to be reduced by the application of integrated therapeutic tools in selected patients handled by expert teams.In conclusion, NPPV has to be considered as a rational art and not just as an application of science, which requires the ability of clinicians to both choose case-by-case the best "ingredients" for a "successful recipe" ( patient selection, interface, ventilator, interface, ) and to avoid a delayed intubation if the ventilation attempt fails.

Clinical scoring for the failure of non-invasive ventilation in acute respiratory failure patients in the Emergency Department.

“…Non-invasive mechanical ventilation (NIV) is an alternative therapy to avoid the lifethreatening risks of invasive mechanical ventilation. It uses ventilatory support via the patient's upper airway using a mask or similar device (3,10). Absolute contraindications of NIV contain cardiorespiratory arrest, extreme psychomotor agitation, severe hemodynamic instability, nonhypercapnic coma, and multiple organ failure (3).…”

“…It uses ventilatory support via the patient's upper airway using a mask or similar device (3,10). Absolute contraindications of NIV contain cardiorespiratory arrest, extreme psychomotor agitation, severe hemodynamic instability, nonhypercapnic coma, and multiple organ failure (3). NIV is widely used as an effective treatment for acute respiratory failure (ARF), particularly an acute exacerbation of chronic obstructive pulmonary disease (COPD) and cardiogenic pulmonary edema since the 1980s (11).…”

“…Noninvasive ventilation (NIV) refers to the delivery of mechanical ventilation without using an invasive artificial airway (endotracheal tube or tracheostomy tube) that markedly increases over the past two decades worldwide (3). NIV has become an alternative to orotracheal intubation and invasive mechanical ventilation for the management of ARF, since it can decrease the length of stay in the ICU, reduce the number of possible complications, increase the quality of life, reduce risk of infection and improve the chance of survival, compared to conventional invasive ventilation (4)(5)(6).…”

In Response to Mamo et al. Noninvasive Ventilation After Thoracoabdominal Aortic Surgery: Is the Prevention of Postoperative Pulmonary Complications Rock-solid?

“…We believe that these are important from the methodologic point of view. 2,3 Moreover, we assume that all patients were hypoxemic and nonhypercapnic, and we do not know if hypercapnia was contemplated in the study. The authors describe the protocol of 8-hour NIV use for 2 hours; however, we do not know if it is previously validated and if the authors used any reference.…”

Effect of Inspiratory Absolute Humidity on Leak During NPPV

“…Noninvasive positive pressure ventilation (NPPV) via face mask has markedly increased over the past two decades [1]. NPPV have indicated effective for the patients, for instance respiratory failure, heart failure and sleep apnea syndrome [2][3][4]. Complications, such as sore throat, pharynx edema or the recurrent laryngeal nerve paralysis, get decreasing to support ventilation without the endotracheal intubation and tracheostomy.…”