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Semin Respir Crit Care Med 2014; 35(04): 492-500
DOI: 10.1055/s-0034-1383863
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Noninvasive Ventilation for Patients with Hypoxemic Acute Respiratory Failure

Laurent Brochard
1   Keenan Research Centre and Critical Care Department, Saint Michael's Hospital, Toronto, Ontario, Canada
2   Faculty of Medicine, University of Toronto, Ontario, Canada
3   Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, Switzerland
,
Jean-Claude Lefebvre
3   Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, Switzerland
4   Division of critical care medicine, Université Laval, Québec, Canada
,
Ricardo Luiz Cordioli
3   Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, Switzerland
5   Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
,
Evangelia Akoumianaki
3   Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, Switzerland
6   Department of Intensive Care Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
,
Jean-Christophe M. Richard
3   Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, Switzerland
7   Emergency Department, General Hospital of Annecy, Annecy, France
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Publikationsverlauf

Publikationsdatum:
11. August 2014 (online)

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Abstract

Noninvasive ventilation (NIV) has an established efficacy to improve gas exchange and reduce the work of breathing in patients with hypoxemic acute respiratory failure. The clinical efficacy in terms of meaningful outcome is less clear and depends very much on patient selection and assessment of the risks of the technique. The potential risks include an insufficient reduction of the oxygen consumption of the respiratory muscles in case of shock, an excessive increase in tidal volume in case of lung injury, and a risk of delayed or emergent intubation. With a careful selection of patients and a rapid decision regarding the need for intubation in case of failure, great benefits can be offered to patients. Emerging indications include its use in patients with treatment limitations, in the postoperative period, and in patients with immunosuppression. This last indication will necessitate reappraisal because the prognosis of the conditions associated with immunosuppression has improved over the years. In all cases, there is both a time window and a severity window for NIV to work, after which delaying endotracheal intubation may worsen outcome. The preventive use of NIV seems promising in this setting but needs more research. An emerging interesting new option is the use of high flow humidified oxygen, which seems to be intermediate between oxygen alone and NIV.

Keywords

mechanical ventilation - continuous positive airway pressure - hypoxemia - gas exchange - acute lung injury - acute respiratory distress syndrome
 

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