37 - Non-invasive ventilation

Abstract

Non-invasive ventilation (NIV) has been successfully applied in patients with acute respiratory failure (ARF) caused by cardiogenic pulmonary oedema (CPO), chronic obstructive pulmonary disease (COPD) and chronic respiratory failure due to sleep apnoea and neuromuscular disorders. NIV should be considered as standard therapy for respiratory support in these patients before considering invasive mechanical ventilation. Continuous positive airway pressure (CPAP) alone appears to be beneficial in ARF due to CPO and COPD with threshold load. Bilevel (or pressure support ventilation with CPAP) is beneficial in patients with hypercapnic ARF secondary to respiratory muscle insufficiency, high inspiratory workloads or reduced alveolar ventilation. NIV does not appear to benefit patients with severe pneumonia, acute respiratory distress syndrome or postoperative respiratory failure. Its role in ARF due to pneumonia in immune-compromised subjects, acute asthma and blunt chest trauma remains unclear.