Noninvasive Ventilation For Patients In Acute Respiratory Distress: An Update
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Noninvasive Ventilation For Patients In Acute Respiratory Distress: An Update
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Publication Date: January 2017 (Volume 19, Number 2)

CME: This issue includes 4 AMA PRA Category 1 Credits™; 4 ACEP Category I credits; 4 AAFP Prescribed credits; and 4 AOA Category 2 A or 2B CME credits.

Authors

Nikita Joshi, MD
Clinical Instructor, Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA
 
Molly K. Estes, MD
Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA
 
Kayla Shipley, MD
Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA
 
Hyun-Chul Danny Lee, MD
Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA
 
Peer Reviewers
 
John M. Litell, DO
Intensivist, Department of Critical Care, Abbott Northwestern Hospital, Minneapolis, MN
 
Kyle B. Walsh, MD
Assistant Professor, Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH
 
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.
 

Excerpt From This Issue

Just as you are able to sit down for the first time in hours in the ED, a colleague walks by and says, “I don’t know what’s going on with your new patient, but she doesn’t look good.” You hurry to find a frail, elderly woman sitting upright, mouth agape. She is tachypneic, with a respiratory rate of 40 breaths/min, and is using accessory respiratory muscles. According to EMS, her pulse oximetry reading improved from 67% on 2-L nasal cannula to 80% on a 15-L nonrebreather mask. She has virtually no breath sounds on lung auscultation except for occasional faint wheezing. You initiate bilevel noninvasive ventilation (NIV), and inline continuous nebulizer treatments are started. The respiratory therapist suggests endotracheal intubation, and you suspect that extubation in the ICU will be difficult, further along the treatment course. As the respiratory therapist sets the bilevel NIV at a PIP 12 over PEEP 5, she asks you, “What parameters would make you decide to proceed with endotracheal intubation?”

 

Product Reviews
Javaid Abbasi, DO - 07/25/2017
Excellent article!
Kerith Joseph, MD - 07/21/2017
This was an excellent article. Just the right length. I will now consider different types of ventilation masks for NIV.

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