Key points Non-invasive Ventilation
– The strongest evidence for use of non-invasive ventilation (NIV) is in patients with respiratory failure secondary to either chronic obstructive pulmonary disease or cardiogenic pulmonary oedema
– NIV is emerging as an alternative to MV in a number of different clinical situations.
– When NIV is commenced outside critical care, a defined plan should already be in place if NIV is unsuccessful.
– NIV should not delay intubation and MV in those patients who fail to respond to or deteriorate on NIV.
– Type Il respiratory failure, COPD, It is now considered the first-line therapy in COPD but patients with severe academia (pH<7.25) and hypercarbic coma considered as contraindications to NIV.
– Some small RCTs suggest that using NPPV in acute exacerbations of asthma may improve respiratory parameters and reduce intubation rates.
– NIV Indicated in morbid obesity, associated with certain respiratory syndromes such as obstructive sleep apnoea and chronic alveolar hypoventilation.
– The use of NIV has been demonstrated to improve quality of life and survival in patients with advanced neuromuscular disorders
– There is good evidence to support the use of NIV in acute pulmonary oedema. Theoretical benefits include a reduction in both preload and afterload and improved oxygenation and reduced work of breathing
– Respiratory failure due to chest trauma or contusions responds well to NIV and may improve mortality compared with ‘standard treatment.
– The use of NIV in recently extubated patients provides an attractive alternative to MV and may improve outcomes and mortality
– Ater abdominal surgery, basal atelectasis, prolonged supine position, and diaphragmatic splinting may all Contribute to the development of postoperative respiratory failure. The use of NIV both prophylactically and as a treatment for hypoxic respiratory has been demonstrated to reduce reintubation rates and mortality in abdominal visceral surgery and cardiac surgery,
– In thoracic surgery, acute respiratory failure (ARF) after pneumonectomy or lobectomy confers a significant risk of poor outcome. NIV is safe and may reduce both reintubation rates and mortality in this at-risk surgical group.