Abstract
Non-invasive ventilation has gained an increasingly pivotal role in the treatment of acute hypoxemic and/or hypercapnic respira-tory failure and offers multiple advantages over invasive mechanical ventilation. Some of these advantages include the preserva-tion of airway defense mechanisms, a reduced need for sedation, and an avoidance of complications related to endotracheal intubation. Despite its advantages, non-invasive ventilation has some contraindications that include, among them, severe encephalopathy. In this review article, the rationale, evidence, and drawbacks of the use of noninvasive ventilation in the context of hypercapnic and non-hypercapnic patients with an altered level of consciousness are analyzed.
Highlights
Material and methodsThe utility of non-invasive ventilation (NIV) has been fully proven and well documented in several categories of patients with acute respiratory failure (ARF) [1,2,3]
We reviewed the published literature examining the use of NIV in patients with hypercapnic encephalopathy
We reviewed published studies designed to assess the use of NIV as a first-line intervention in hypoxemic ARF to avoid endotracheal intubation (ETI)
Summary
The utility of non-invasive ventilation (NIV) has been fully proven and well documented in several categories of patients with acute respiratory failure (ARF) [1,2,3]. Most studies use the Glasgow coma scale (GCS) or the Kelly-Matthay score (KMS) to assess the level of consciousness. In a study by Briones et al [19], the effectiveness of positive pressure NIV compared to IMV was assessed in two cohorts of twelve patients each with similar baseline characteristics (GCS < 8, arterial pH < 7.25, APACHE II scores). Both groups presented to the Emergency Department with severe hypercapnia secondary to an acute exacerbation of COPD. Diaz et al [20] prospectively examined patients with hypercapnic coma (GCS ≤ 8) secondary
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