NONINVASIVE MECHANICAL VENTILATION IN PATIENTS WITH ACUTE RESPIRATORY-FAILURE

Objectives: a) To describe the introduction of noninvasive means to pr ovide positive pressure ventilation in acute respiratory failure; b) t o describe the physiologic response to noninvasive ventilation; c) to review the current published literature on using noninvasive ventilati on in patients with acute hypercapnic and/or hypoxemic respiratory fai lure; d) to describe the technique of applying mask ventilation and cu rrent recommendations for using noninvasive ventilation in patients wi th acute respiratory failure; and e) to discuss the advantages and dis advantages of noninvasive ventilation. Data Sources: All relevant arti cles published in the English medical literature from 1988 through Aug ust 1994 were retrieved through a MEDLINE search, as well as from the authors' experience. Study Selection: Studies were selected based on t he use of positive-pressure mechanical ventilation delivered, using fa cial or nasal masks in various acute settings of respiratory failure. Data Extraction: The authors extracted all applicable data. Data Synth esis: Studies were analyzed according to the type of respiratory failu re (hypercapnic vs. hypoxemic) and the underlying conditions where non invasive ventilation seemed to be a better alternative. The results we re evaluated based on types of masks used and modes of ventilation, Ou tcome measures were compared based on studies that randomized patients with acute respiratory failure to receive noninvasive ventilation vs, conventional therapy, Complications of noninvasive ventilation, mainl y local, were compared with those complications seen with endotracheal intubation in acute respiratory failure patients, Conclusions: Noninv asive ventilation is a safe and effective means of ventilatory support for many patients with acute respiratory failure, particularly those patients with hypercapnic respiratory failure. Noninvasive ventilation is well tolerated, principally because it allows the patient to be in control and to continue verbal communication, and should he strongly considered in managing terminally ill patients with potentially revers ible causes of respiratory failure, The duration of mechanical ventila tion and its associated complications are significantly decreased in h ypercapnic respiratory failure with noninvasive ventilation.