Clinical review: Noninvasive ventilation in the clinical setting--experience from the past 10 years

Abstract

This brief review analyses the progress of noninvasive ventilation (NIV) over the last decade. NIV has gained the dignity of first line intervention for acute exacerbation of chronic obstructive pulmonary disease, assuring reduction of the intubation rate, rate of infection and mortality. Despite positive results, NIV still remains controversial as a treatment for acute hypoxemic respiratory failure, largely due to the different pathophysiology of hypoxemia. The infection rate reduction effect achieved by NIV application is crucial for immunocompromised patients for whom the endotracheal intubation represents a high risk. Improvements in skills acquired with experience over time progressively allowed successful treatment of more severe patients.

Figure 1

Patient undergoing pressure support ventilation with a helmet. The transparency of the device permits interaction of the patient with their surroundings. ASV, antisuffocation valve, which opens automatically if disconnection from the ventilator occurs; Br, armpit braces that keep the helmet attached to the patient; C, collar; Inlet, inlet of medical gases, connected to the inspiratory port of the ventilator by conventional tubing; Outlet, outlet of gases, connected to expiratory port of the ventilator; P, sealed passage for the nasogastric tube (NGT), through which the patient can receive enteral feeding or drink through a straw (picture taken with patient permission).