Critical Care and Shock

Non-invasive ventilation: When does it fail?


Non-invasive ventilation is a common form of ventilatory support via the patient’s upper airway using a mask [1,2]. Although initially used in patients with neuromus cular disease NIV is accepted as the standard in hypercapnic and hypoxemic acute respiratory failure cause by COPD, restrictive lung disease from chest wall deformity, neuromuscular disease, pulmonary edema, ARF in cancer patients, and asthma [3-9].

The study by Phua and coworkers is important to critical care practitioners and consistent with previous NIV success rate reports [6-8]. This trial, compared to previous studies, compares NIV in different lung conditions attempting to predict success and failure rates.

NIV has several advantages in modern acute care medicine and for patients with chronic respiratory and neuromuscular disorders. Plant and colleagues, in a clinical study demonstrated that NIV is highly cost-effective in both reducing the costs and decreasing in-hospital mortality in patients with COPD and ARF in the United Kingdom [10]. When properly applied, NIV reduces the need for ETI and its associated complications.

NIV application for a variety of clinical conditions continues to evolve as the patient-ventilator interfaces are becoming widely used. New interesting devices are emerging, like a closed Helmet system described by Pelosi and associates [13]. Utilizing simpler devices and interfaces will allow clinicians to widely use NIV. However, clinicians must be aware of predictors of failure of NIV and their consequences.

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