Noninvasive Ventilation for Acute Respiratory Failure

Noninvasive ventilation (NW) for acute respiratory failure has gained much academic and clinical interest. Despite this, NIV is underutilized. The evidence strongly supports its use in patients presenting with an exacerbation of COPD and in patients with acute cardiogenic pulmonary edema. As reviewed in this paper, there is now evidence supporting or not supporting the use of NIV in various other presentations of acute respiratory failure. It is important not only to know when to initiate NIV, but also when this therapy is failing. Whether NW in the setting of acute respiratory failure can be managed appropriately outside the ICU setting is controversial. Although a variety of interfaces are available, the oronasal mask is the best initial interface in terms of leak prevention and patient comfort. Some critical care ventilators have NW modes that compensate well for leaks, but as a group the ventilators that are designed specifically for NW have better leak compensation. NW should be part of the armamentarium of all clinicians caring from patients with acute respiratory failure. (C) 2013 Daedalus Enterprises