NIV in acute

respiratory failure

Despite its proven benefits to improve mortality, address patient discomfort, and reduce costs, NIV for acute respiratory failure is still underutilized at many hospitals.

 

It is rare for a medical technology to simultaneously improve mortality, address patient discomfort, and reduce costs. Non-invasive positive pressure ventilation (NPPV) or NIV (Noninvasive ventilation) achieves this unusual health services “hat trick”. Unfortunately, noninvasive ventilation appears to be underutilized at many hospitals.

 

As stated by Hess in a recent publication in Respiratory care in June 2013: “Noninvasive ventilation (NIV) for acute respiratory failure has gained much academic and clinical interest. Despite this, NIV is underutilized.”¹

 

For example Sweet at al. found in a study that despite meeting the criteria for NIV (NPPV), only one third of those patients actually received the treatment.²

 

There are over 1,000 articles on the use of NIV, with over 100 of these reporting randomized, controlled trials. Literature identifies four groups of patients for which non-invasive has proven beneficial: Patients with exacerbations of chronic obstructive pulmonary disease (COPD) form the most important group of patients for which NIV has a proven benefit. Patients with pulmonary edema from heart failure are the second group of patients for which there is strong evidence to support the application of NIV.

 

The third group for which there is compelling evidence for the benefit of NIV includes patients with impaired immune function (immunosuppressed). Also NIV can play an important role in weaning. Benefits have also been reported in non-acute patients, e.g. patients suffering from OSA, Obesity hypoventilation or chronic respiratory failure.

 

 

NIV is underutilized, despite the robust evidence supporting its use³

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Side note

The terms CPAP and NIV are sometimes used interchangeably. They are, however, distinctly different. With noninvasive CPAP, a face mask or other interface is used to apply a pressure greater than atmospheric to the proximal airway. The result is splinting open the upper airway, an increase in lung volume, and an increase in intrathoracic pressure. With CPAP there is no inspiratory muscle unloading; in fact, tidal ventilation is completely dependent on the respiratory muscles with CPAP.

 

NIV, on the other hand, applies a pressure during the inspiratory phase greater than the pressure applied during exhalation. Thus, NIV unloads the respiratory muscles and can provide complete respiratory support.

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thinkNIV

 

Despite its proven benefits to improve patient comfort and reduce mortality and also costs, noninvasive ventilation (NIV) is still underutilized at many hospitals. This website is designed to promote the usage of NIV by sharing the many situations in which NIV improves patients’ outcomes as well as to inform about the factors which are important in order to perform successful NIV.

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