Measures of Improvement for Noninvasive Positive Pressure Ventilation in the ICU

Abstract

Noninvasive ventilation (NIV) has been used for decades in the ICU to treat acute and chronic respiratory failure from many causes [1]. Multiple randomized, controlled trials have proven the benefits of bi-level noninvasive positive pressure ventilation in patients with hypercapnic respiratory failure from an acute exacerbation of chronic obstructive pulmonary disease (COPD) and in patients with cardiogenic pulmonary edema [2]. In acute hypoxemic respiratory failure from pneumonia and sepsis, bi-level has been shown to improve respiratory status [3]. NIV has also been shown to improve reintubation outcomes in the transition time from invasive ventilation to spontaneous breathing in patients with COPD [4, 5]. The clinician caring for these acutely ill patients on noninvasive ventilation needs to have parameters to measure improvement of respiratory status. This will enable the safe use of noninvasive ventilation for acute respiratory failure and allow the operator to escalate to invasive ventilation when appropriate. In this chapter, we will review these measures of improvement for different types of acute respiratory failure: hypercapnia from COPD, respiratory failure associated with left ventricular dysfunction, and noninvasive positive pressure ventilation for respiratory failure due to pneumonia.