Noninvasive ventilation

Combines positive end expiratory pressure (PEEP) and inspiratory support by preventing alveolar collapse, improves oxygenization and reduces the work of breathing.

Noninvasive positive pressure ventilation reduces need for mechanical ventilation and mortality in COPD exacerbations or cardiogenic pulmonary edema.

Decreases work of breathing and improves gas exchange.

Observational studies with noninvasive ventilation and acute hypoxia respiratory failure indicate a treatment failure rate as high as 50%.

Data does not support use of noninvasive positive pressure ventilation in hypercapneic acute hypoxemic respiratory failure.

Lowers the risk of nosocomial infections when compared to mechanical ventilation.

The ventilatory mode of choice in selected patients with respiratory failure caused by COPD.

For patients who are spontaneously breathing with acute respiratory failure,noninvasive positive pressure ventilation with a tight fitting facemask reduces morbidity and mortality in patients with acute respiratory failure caused by exacerbation of COPD.

Noninvasive ventilation is a value in some patients with hypoxemia from cardiogenic pulmonary edema.

Bronchiectasis and cystic fibrosis may lead to acute hypercapnic respiratory failure (AHRF), and NIV may be used similarly as for COPD.


In people with chest wall deformity or neuromuscular disease, NIV may be used if the CO2 level is elevated.


In neuromuscular disease, the vital capacity is used to determine a need for breathing support.


Obesity hypoventilation syndrome (OHS) may cause acute hypercapnic respiratory failure. 


NIV use in acute cardiogenic pulmonary edema caused by decompensated heart failure, has shown a reduced risk of death and a decreased need for tracheal intubation.


Acute severe asthma may cause acute hypercapnic respiratory failure. 


Whether NIV is effective in this situation, is not clear: NIV is only used in an intensive care unit setting where further deterioration can be managed immediately.


With chronic asthma and fixed airways disease that resembles COPD, NIV may be used.


NIV  may be used in respiratory failure that may develop after major surgery. 


NIV may be used during the recovery period.


NIV may be used to prevent recurrence of mechanical ventilation on the intensive care unit.


If respiratory failure does develop, recommencement of mechanical ventilation is recommended over NIV.


In patients ventilated for hypercapnic respiratory failure, NIV may be used to facilitate the weaning process.


Chronic use of NIV may be indicated for severe COPD.


Home NIV may also be indicated in people with neuromuscular disease and chest wall deformity.


People with motor neuron disease (MND) may require home NIV.


This is the same as non-invasive positive pressure ventilation(NPPV or NIPPV).

Postoperative respiratory failure is a common indication for invasive mechanical ventilation and accounts for more than 20% of all patients receiving ventilatory support.

To facilitate early extubation and prevent postoperative respiratory failure noninvasive ventilation with positive pressure is utilized to reduce the work of breathing, increase and expiratory lung volume and improve oxygenation.

The use of noninvasive continuous positive airway pressure following abdominal surgery reduces postoperative pulmonary complications, including the need for reintubation.

In patients following lung resection the use of NIV with inspiratory pressure assist decreased re intubation rates by half versus usual care with supplemental oxygen, chest physiotherapy and bronchodilators alone.

In mechanically ventilated patients at high risk of extubation failure, the use of high flow nasal oxygen with non-invasive ventilation immediately after excavation significantly decreases the risk of re-intubation compared with high flow nasal oxygen alone.

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