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New advances in the use of noninvasive ventilation for acute hypoxaemic respiratory failure

Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy

CORRESPONDENCE: M. Antonelli, Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy. Fax: 39 063013450. E-mail: m.antonelli@rm.unicatt.it

Keywords: acute respiratory distress syndrome, hypoxaemia, noninvasive ventilation, respiratory failure

Noninvasive ventilation (NIV) includes various techniques for augmenting alveolar ventilation without an endotracheal airway. The theoretical advantages of this approach include avoiding the complications associated with endotracheal intubation, improving patient comfort, preserving airway defence mechanisms, speech and swallowing.

The successful application of NIV in hypoxaemic acute respiratory failure (ARF) of varied etiologies has been extensively described but success rate is strictly dependent on ARF etiology and until today the application of NIV strategies in the setting of hypoxaemic ARF is controversial. Larger, controlled studies are required to clarify the role of NIV in the setting of hypoxaemic ARF.

The correct choice of the patient ventilator interface is a crucial issue in noninvasive ventilation. The study of new interfaces could improve tolerability reducing the noninvasive ventilation failure rate.