Abstract
Noninvasive mechanical ventilation (NIV) is widely used in both acute and chronic respiratory failure and requires careful monitoring and titration to ensure its success and avoid complications. It has been proven effective in acute exacerbation of chronic obstructive pulmonary disease (COPD) and acute respiratory failure secondary to cardiogenic pulmonary edema. It is also used as a home care therapy in patients with chronic pulmonary or sleep disorders.
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Keywords
- Noninvasive ventilation
- Respiratory failure
- Chronic obstructive pulmonary disease
- Acute cardiogenic pulmonary edema
Noninvasive ventilation (NIV) refers to the delivery of ventilatory support into the lungs without an invasive artificial airway (endotracheal tube or tracheostomy tube), usually through a mask [1].
Since the first studies of NIV in critical care around 1980, thousands of reports have been published exploring different clinical applications, modalities, interfaces, and comparisons with other therapies [2].
Before starting NIV, it is crucial to recognize if the patient is a good candidate. The indications for NIV vary according to the underlying cause, severity of illness, and complicating factors [1].
NIV can be used as ventilatory support for patients with acute or chronic respiratory failure. In fact, NIV is widely used in the acute care setting for acute respiratory failure (ARF) across a variety of etiologies. Its effectiveness has been proven for common clinical conditions in critical care, such as exacerbation of chronic obstructive pulmonary disease (COPD) with hypercapnic respiratory acidosis and acute cardiogenic pulmonary edema (ACPE). It is also used as a home care therapy in patients with other chronic pulmonary diseases or sleep disorders.
In ARF, inclusion criteria for NIV are dyspnea, tachypnea (respiratory rate > 25 breaths per minute), increased work of breathing, and hypercapnic respiratory acidosis (PaCO2 > 45 mmHg, pH <7.35) [3].
In acute exacerbation of COPD, bilevel NIV should be started when pH <7.35 and PaCO2 > 45 mmHg persist or develop despite optimal medical therapy. Bilevel NIV remains the preferred choice for patients with COPD who develop acute respiratory acidosis during hospital admission. There is no lower limit of pH below which a trial of NIV is inappropriate, but the lower the pH, the greater the risk of failure. Patients must be very closely monitored with rapid access to endotracheal intubation and invasive ventilation if not improving [4, 5].
In ACPE, either bilevel NIV or continuous positive airway pressure (CPAP) improves respiratory mechanics and facilitates left ventricular work by decreasing left ventricular afterload.
In acute asthma, there is not enough evidence to support the use of NIV [4].
Surgery, particularly that approaching the diaphragm, may have deleterious effects on the respiratory system, causing hypoxemia, decrease in lung volume, and atelectasis. Bilevel NIV and CPAP are frequently used in these clinical situations [4].
CPAP is the first-line treatment for obstructive sleep apnea (OSA), because it eliminates obstructive apneic and hypopneic events, resulting in improved daytime symptoms and reducing adverse cardiovascular outcomes [1, 6].
NIV is considered a significant treatment option for patients with obesity hypoventilation syndrome (OHS). Volume-assured modes of providing NIV may be more effective when high inflation pressures are required [1].
Home NIV can be used in conditions that can lead to chronic ventilatory failure such as scoliosis, kyphosis, thoracoplasty, muscular dystrophy, and motor neuron diseases [1].
NIV is currently used in a wide range of settings, from the ICU to home care. The appropriate selection of patients and the capacity of the team and the patients to achieve a proper adaptation to the technique are the bottom line for success [7].
References
Mas A, Masip J. Noninvasive ventilation in acute respiratory failure. Int J COPD. 2014;9:837–52.
Cortegiani A, Russotto V, Antonelli M, et al. Ten important articles on noninvasive ventilation in critically ill patients and insights for the future: a report of expert opinions. BMC Anesthesiol. 2017;17(1):122. Published 2017 Sep 4. https://doi.org/10.1186/s12871-017-0409-0.
Davidson AC, Banham S, Elliott M, et al. BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults. Thorax. 2016;71:ii1–ii35.
Rochwerg B, Brochard L, Elliott MW, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017;50:1602426. https://doi.org/10.1183/13993003.02426-2016.
Dretzke J, Wang J, Yao M, Guan N, Ling M, Zhang E, Mukherjee D, Hall J, Jowett S, Mukherjee R, Moore DJ, Turner AM. Home non-invasive ventilation in COPD: a global systematic review. Chronic Obstr Pulm Dis. 2022;9(2):237–51. https://doi.org/10.15326/jcopdf.2021.0242. PMID: 35259290
Navarra SM, Congedo MT, Pennisi MA. Indications for non-invasive ventilation in respiratory failure. Rev Recent Clin Trials. 2020;15(4):251–7. https://doi.org/10.2174/1574887115666200603151838. PMID: 32493199
Chawla R, Dixit SB, Zirpe KG, Chaudhry D, Khilnani GC, Mehta Y, Khatib KI, Jagiasi BG, Chanchalani G, Mishra RC, Samavedam S, Govil D, Gupta S, Prayag S, Ramasubban S, Dobariya J, Marwah V, Sehgal I, Jog SA, Kulkarni AP. ISCCM guidelines for the use of non-invasive ventilation in acute respiratory failure in adult ICUs. Indian J Crit Care Med. 2020;24(Suppl 1):S61–81. https://doi.org/10.5005/jp-journals-10071-G23186. PMID: 32205957; PMCID: PMC7085817
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Ferro, A.R.C. (2023). Noninvasive Ventilation: Rationale and Indications. In: Esquinas, A.M., De Vito, A., Barbetakis, N. (eds) Upper Airway Disorders and Noninvasive Mechanical Ventilation. Springer, Cham. https://doi.org/10.1007/978-3-031-32487-1_9
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DOI: https://doi.org/10.1007/978-3-031-32487-1_9
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