Objective: To critically assess available high-level clinical studies regarding use of noninvasive positive pressure ventilation in varied intensive care unit settings.
Data Source: Search of pertinent articles within Ovid MEDLINE from 1975 to 2005, CINAHL from 1982 to 2005, EMBASE from 1988 to 2005, and Web of Science from 1993 to 2005.
Study Selection: Randomized, controlled clinical trials and cohort studies and observational studies the authors consider important or novel.
Data Extraction/Synthesis: Performed equally by both authors with the use of an Excel data spreadsheet.
Conclusion: There is abundant level I evidence supporting the use of noninvasive positive pressure ventilation in such critical care settings as acute hypercapnic respiratory failure, particularly related to chronic obstructive pulmonary disease, and acute cardiogenic pulmonary edema. We also report on other clinical scenarios in which the data may be somewhat less compelling, but evidence favors a noninvasive positive pressure ventilation trial. Some well designed studies suggest that noninvasive positive pressure ventilation is not an appropriate intervention for patients who have failed endotracheal extubation.