RT Book, Section
A1 Brochard, Laurent
A2 Hall, Jesse B.
A2 Schmidt, Gregory A.
A2 Wood, Lawrence D.H.
SR Print(0)
ID 2286731
T1 Chapter 33. Noninvasive Ventilation
T2 Principles of Critical Care, 3e
YR 2005
FD 2005
PB The McGraw-Hill Companies
PP New York, NY
SN 9780071416405
LK accessanesthesiology.mhmedical.com/content.aspx?aid=2286731
RD 2022/08/14
AB Many  patients  with  ventilatory  failure  can  be  successfully  managed  with  noninvasive  positive  pressure  ventilation  (NIPPV).NIPPV  improves  gas  exchange,  reduces  the  work  of  breathing,  and  relieves  dyspnea.Patients  most  likely  to  benefit  include  those  with  acute  hypercapnic  exacerbations  of  chronic  obstructive  pulmonary  disease  (COPD)  or  hypercapnic  forms  of  acute  cardiogenic  pulmonary  edema.In  selected  patients  with  acute  hypoxemic  nonhypercapnic  respiratory  failure,  NIPPV  may  obviate  the  need  for  endotracheal  intubation.  Selection  may  require  exclusion  of  patients  with  hemodynamic  instability,  central  neurologic  dysfunction,  or  an  inability  to  protect  the  upper  airway.In  severely  hypoxemic  patients,  undiscerning  use  of  NIPPV  may  inappropriately  delay  intubation.  In  these  patients,  the  decision  to  switch  to  endotracheal  intubation  should  be  made  early.The  use  of  NIPPV  to  treat  postextubation  respiratory  distress  has  not  been  found  to  be  superior  to  conventional  management.The  first  hour  on  NIPPV  is  crucial  in  predicting  the  outcome  and  requires  that  experienced  physicians,  nurses,  or  respiratory  therapists  spend  considerable  time  at  the  bedside.A  favorable  response  to  NIPPV  is  usually  apparent  within  the  first  hour.  Absence  of  improvements  in  dyspnea,  respiratory  rate,  and  gas  exchange  within  1  hour  strongly  suggests  a  need  for  endotracheal  intubation.Typical  settings  in  a  patient  with  COPD  include  pressure  support  of  10  cm  H2O  above  a  positive  end-expiratory  pressure  (PEEP)  of  5  cm  H2O.In  appropriately  selected  patients,  NIPPV  produces  better  outcomes  than  does  endotracheal  mechanical  ventilation.