Noninvasive Ventilation in Respiratory Failure

Abstract

Use of noninvasive ventilatory support (NIVS) has increased dramatically in recent years. These techniques have been used in both acute and chronic respiratory failure and offer a practical alternative to intubation or tracheostomy in selected patients. The variety of methods available for noninvasive support include negative pressure ventilation, positive pressure ventilation via nasal mask and nasal continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP) device. Beneficial effects of NIVS may include relief of ventilatory muscle fatigue, improvement in lung compliance, and improved central chemoreceptor sensitivity. Potential clinical benefits include symptomatic and gas exchange improvement. NIVS has been used in chronic respiratory failure associated with neuromuscular and chest wall disease as well as in patients with chronic obstructive pulmonary disease (COPD). In acute respiratory failure because of congestive heart failure or COPD, NIVS has been used as an alternative to intubation. The advantages and disadvantages of NIVS must be considered specific to the clinical situation.