The use of non-invasive ventilation in the menagement of patients with acute respiratory failure
Year: 2015
Type: article
Abstract: Noninvasive ventilation (NIV) is intended for patients with acute respiratory failure who will have benefit from ventilatory support, but may not need conventional mechanical ventilation which requires endotracheal intubation. NIV is delivered via tightfitting masks, which obviates the need and complications of endotracheal intubation. This modality enhances patient's comfort, allowing for eating, drinking, cough and communication, avoiding or reducing the need for sedation without an increase in cost and nurse workload compared with invasive mechanical ventilation. Ventilation acquired pneumonia (VAP) and other nosocomial infections are reduced by noninvasive ventilation by preserving airway defence mechanisms, owing to the lower requirement for invasive monitoring. A trained team, careful patient selection and optimal choice of devices can optimise outcome of NPPV but NIV cannot replace endotracheal intubation in all circumstances. Strong evidence supports the use of NIV for acute respiratory failure (ARF): to prevent endotracheal intubation (ETI), as well as to facilitate extubation in patients with acute exacerbations of chronic obstructive pulmonary disease and to avoid ETI in acute cardiogenic pulmonary oedema, and in immunocompromised patients. Weaker evidence supports the use of NIV for patients with ARF due to asthma exacerbations, with post-operative or post-extubation ARF, pneumonia, acute lung injury (ALI), acute respiratory distress syndrome (ARDS), or during bronchoscopy. NIV should be applied under close clinical and physiological monitoring for signs of treatment failure and, in such cases, ETI should be promptly available.
Authors: Sladjana Trpkovic, Aleksandar Pavlović, Nebojša Videnović, Ana Sekulić, Olivera Marinković, Ranko Zdravković
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W3019620153