Noninvasive ventilation in acute respiratory failure

Excerpt

Noninvasive ventilation (NIV) is becoming more widely practised as the benefits of avoiding endotracheal intubation and conventional mechanical ventilation are established. These benefits include reduced risk of nosocomial infection, reduced incidence of barotrauma and either avoidance of the need for admission to an intensive care unit (ICU) or shortening of ICU stay. Initial concerns about poor patient acceptance and increased workload in the ICU seem to have been unfounded as the technology has improved and familiarity with the techniques increased. Several studies have shown considerable benefit in the management of exacerbation of chronic obstructive pulmonary disease (COPD) for reducing or avoiding ICU admission and reducing complications. Case series showing the advantages of NIV in the management of acute pulmonary oedema, acute severe asthma and community-acquired pneumonia have also been published. This study is one of the first prospective randomised studies looking at the role of noninvasive ventilation in all causes of respiratory failure (see methods for exceptions). The results suggest that NIV reduces the need for intubation in patients with respiratory failure, but the numbers are too small to show a survival advantage. The increasing body of evidence favouring noninvasive management in the initial or overall management of respiratory failure suggests that this is likely to become an established tool for the emergency medicine and intensive care practitioner in the future. …