Chapter 11: Noninvasive Ventilation

Introduction

One of the significant advances in respiratory critical care over the past 20 years has been the emergence of noninvasive ventilation (NIV). NIV is used increasingly in patients with acute respiratory failure. In appropriately selected patients, need for intubation is reduced with the use of NIV. Because an artificial airway increases the risk of nosocomial pneumonia, it is not surprising that use of NIV decreases the incidence of ventilator-associated pneumonia. In some clinical settings, such as chronic obstructive pulmonary disease (COPD) exacerbation or acute cardiogenic pulmonary edema, the use of NIV affords a survival benefit. This chapter covers clinical and technical issues related to use of NIV.

Patient Factors

Patient Selection

The strength of evidence for the use of NIV for various causes of acute respiratory failure is summarized in Table 11-1. High-level evidence supports the effectiveness of NIV for COPD exacerbation. Equally strong evidence supports the use of NIV for acute cardiogenic pulmonary edema. There is also evidence to support the use of NIV in patients with respiratory failure following solid organ transplantation and those who are immunosuppressed. Although some evidence supports the use of NIV for acute asthma, the evidence in this setting is weak. The use of NIV as an alternative to invasive ventilation in severely hypoxemic patients with acute respiratory distress syndrome is not recommended.

NIV can be used to allow earlier ...