Non-invasive ventilation in acute respiratory failure

• Published in: The Lancet (British edition) Vol. 374; no. 9685; pp. 250 - 259
• Main Authors: Nava, Stefano, MD, Hill, Nicholas, MD
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 18.07.2009; Elsevier; Elsevier Limited
• Subjects: Acute Disease; Adult; Airway management; Biological and medical sciences; Chronic obstructive pulmonary disease; Contraindications; Critical Care - methods; Equipment Design; Evidence-Based Medicine; General aspects; Hospitals; Humans; Immunocompromised Host; Intensive care; Internal Medicine; Intubation, Intratracheal - adverse effects; Masks; Medical sciences; Mortality; Patient Selection; Personnel Staffing and Scheduling; Positive-Pressure Respiration - economics; Positive-Pressure Respiration - instrumentation; Positive-Pressure Respiration - methods; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Edema - complications; Respiratory Insufficiency - etiology; Respiratory Insufficiency - therapy; Respiratory therapy; Ventilation; Medicine; Ventilation; Acute respiratory insufficiency; Non invasive method
• ISSN: 0140-6736; 1474-547X; 1474-547X
• DOI: 10.1016/S0140-6736(09)60496-7

Summary Non-invasive mechanical ventilation has been increasingly used to avoid or serve as an alternative to intubation. Compared with medical therapy, and in some instances with invasive mechanical ventilation, it improves survival and reduces complications in selected patients with acute respiratory failure. The main indications are exacerbation of chronic obstructive pulmonary disease, cardiogenic pulmonary oedema, pulmonary infiltrates in immunocompromised patients, and weaning of previously intubated stable patients with chronic obstructive pulmonary disease. Furthermore, this technique can be used in postoperative patients or those with neurological diseases, to palliate symptoms in terminally ill patients, or to help with bronchoscopy; however further studies are needed in these situations before it can be regarded as first-line treatment. Non-invasive ventilation implemented as an alternative to intubation should be provided in an intensive care or high-dependency unit. When used to prevent intubation in otherwise stable patients it can be safely administered in an adequately staffed and monitored ward.