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Noninvasive Ventilation For Patients In Acute Respiratory Distress: An Update

February 2017

Abstract

Over the last 20 years, noninvasive ventilation (NIV) strategies have been used with increasing frequency. The ease of use of NIV makes it applicable to patients presenting in a variety of types of respiratory distress. In this review, the physiology of positive pressure ventilation is discussed, including indications, contraindications, and options for mask type and fit. Characteristics of patients who are most likely to benefit from NIV are reviewed, including those in respiratory distress from chronic obstructive pulmonary disease exacerbation and cardiogenic pulmonary edema. The literature for other respiratory pathologies where NIV may be used, such as in asthma exacerbation, pediatric patients, and community-acquired pneumonia, is also reviewed. Controversies and potential future applications of NIV are presented.

Keywords: noninvasive ventilation, NIV, CPAP, BPAP, BiPAP, positive pressure ventilation, respiratory failure, hypoxia, dyspnea, hypercarbia, chronic obstructive pulmonary disease, COPD, congestive heart failure, pneumonia, asthma, Boussignac, oronasal mask, cardiogenic pulmonary edema, interstitial lung disease, cystic fibrosis, do not intubate

Points

  • Noninvasive ventilation (NIV) relies on the creation of consistent positive airway pressure that results in increased laminar flow, stenting open airways and eliminating dead space. This improves lung filling and directly increases minute ventilation by increasing functional residual capacity and tidal volume.
  • NIV is not a definitive airway, but can often be used to optimize a patient’s respiratory condition without intubation. This is especially useful in patients with do-not-intubate orders.

Pearl

  • NIV can offer rapid resuscitation of the critically ill in the ED and avoid ICU admission.

 

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Last Modified: 10/20/2017
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