[Non-invasive ventilation in the treatment of acute respiratory and chronic ventilatory failure]

Abstract

Non-invasive mechanical ventilation (NIV) has been employed alternatively to invasive mechanical ventilation (IMV) in acute treatment as well as in long-term domiciliary use. In hypercapnic acute respiratory failure (ARF), NIV significantly reduces intubation and mortality rates and should thus be preferred to IMV whenever possible and as quick as possible. On the other hand, NIV is not generally recommended in hypoxemic ARF. Strong evidence supports the use of domiciliary NIV in chronic respiratory failure caused by neuromuscular diseases or by thoracic restrictions. In contrast, its influence on long time survival in COPD patients is not clearly proven. Prescription of home NIV in COPD should therefore be confined to severe degrees of chronic respiratory failure. Adaptive servo ventilation is another ventilatory mode that is increasingly used in patients with chronic heart failure and Cheyne-Stokes respiration.