La ventilation non-invasive au decours de l'intubation

Abstract

The significant advance and clinical benefit of non invasive ventilation (NIV) in the initial management of acute respiratory failure (ARF) led to use this technique as a non invasive ventilatory strategy following intubation (postintubation NIV). In this condition, NIV can be applied in two different indications with potential different results: either to facilitate weaning from endotracheal mechanical ventilation (ETMV) and reduce the duration of intubation or to avoid reintubation in case of ARF occurring within 24 to 72 hours after extubation. Current data show a clinical benefit of NIV, as a strategy of difficult weaning, on the duration of intubation, weaning success, length of stay, ETMV complications as well as mortality, mainly in chronic obstructive pulmonary disease patients. In contrast, the more controversial results observed with NIV applied to the postextubation ARF should lead the clinician to be cautious in its daily clinical practice. In all cases, the postintubation NIV can only be considered with a sufficiently experienced team in the technique and should not unnecessarily delay the reintubation time. Further studies will be needed to enhance the clinical and economical challenge of such a non invasive ventilatory strategy applied to the postintubation period.