Noninvasive positive-pressure ventilation in acute respiratory failure

Abstract

Noninvasive positive-pressure ventilation is a type of mechanical ventilation that does not require an artificial airway. Studies published in the 1990s that evaluated the efficacy of this technique for the treatment of diseases as chronic obstructive pulmonary disease, congestive heart failure and acute respiratory failure have generalized its use in recent years. Important issues include the selection of the ventilation interface and the type of ventilator. Currently available interfaces include nasal, oronasal and facial masks, mouthpieces and helmets. Comparisons of the available interfaces have not shown one to be clearly superior. Both critical care ventilators and portable ventilators can be used for noninvasive positive-pressure ventilation; however, the choice of ventilator type depends on the patient's condition and therapeutic requirements and on the expertise of the attending staff and the location of care. The best results (decreased need for intubation and decreased mortality) have been reported among patients with exacerbations of chronic obstructive pulmonary disease and cardiogenic pulmonary edema.

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Figure 1: This forest plot represents relative risk estimates comparing noninvasive positive-pressure ventilation with continuous ventilation. The information was assembled from systematic reviews using varying numbers of randomized controlled trials to generate summary statistics., As compared to invasive ventilation, noninvasive methods are superior in decreasing mortality for patients with specific conditions. NPPV = noninvasive positive-pressure ventilation.

Figure 2: Practice guideline for the use of noninvasive positive-pressure ventilation for treatment of acute respiratory failure in patients with chronic obstructive pulmonary disease and congestive heart failure. Modified with permission from The American College of Chest Physicians (Chest 2003;123:2062-73).

Figure 3: Algorithm for weaning from noninvasive positive-pressure ventilation for patients with acute respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Modified with permission from Elsevier (J Crit Care 2004;19:82-91).

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