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Noninvasive positive pressure ventilation in the acute care setting: where are we?

¹ Pulmonary and Respiratory Intensive Care Unit, Cardio-Thoracic Dept, University Hospital Pisa, Pisa, and ² Weaning and Pulmonary Rehabilitation Unit, Auxilium Vitae, Volterra, Italy.

CORRESPONDENCE: N. Ambrosino, U.O. Pneumologia, Dipartimento Cardio-Toracico, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, Cisanello, 56124 Pisa, Italy. Fax: 39 050996779. E-mail: n.ambrosino{at}ao-pisa.toscana.it

Keywords: Acute respiratory failure, chronic obstructive pulmonary disease, endotracheal intubation, mechanical ventilation, noninvasive ventilation

Received: October 31, 2007
Accepted December 27, 2007

Noninvasive positive pressure ventilation (NPPV) is a technique used to deliver mechanical ventilation that is increasingly utilised in acute and chronic conditions. The present review examines the evidence supporting the use of NPPV in acute respiratory failure (ARF) due to different conditions.

Strong evidence supports the use of NPPV for ARF to prevent endotracheal intubation (ETI), as well as to facilitate extubation in patients with acute exacerbations of chronic obstructive pulmonary disease and to avoid ETI in acute cardiogenic pulmonary oedema, and in immunocompromised patients. Weaker evidence supports the use of NPPV for patients with ARF due to asthma exacerbations, with post-operative or post-extubation ARF, pneumonia, acute lung injury, acute respiratory distress syndrome, or during bronchoscopy. NPPV should be applied under close clinical and physiological monitoring for signs of treatment failure and, in such cases, ETI should be promptly available. A trained team, careful patient selection and optimal choice of devices can optimise outcome of NPPV.

Noninvasive positive pressure ventilation is increasingly being used in the management of acute respiratory failure but caregivers must respect evidence-supported indications and avoid contraidincations. Additionally, the technique must be applied in the appropriate location by a trained team in order to avoid disappointing results.