Other indications

for NIV

There are other groups for which noninvasive ventilation is an important option including ARDS (acute respiratory distress syndrome), asthma, pneumonia and post-operative patients. It is important that these patients are closely monitored when treated with NIV.

 

While the evidence for use of NIV is strongest in patients with acute respiratory failure from COPD exacerbation, pulmonary edema, and impaired immune function, there are other patient groups for which NIV is an important option. These other groups include patients with the following conditions:

 

 

  • Asthma: Invasive mechanical ventilation in asthmatic patients is associated with a higher risk of complications and should therefore be a measure of last resort. Patients in acute asthma exacerbation may benefit from early respiratory support with NIV. It should be noted, however, that reports of the use of NIV in asthma patients are scarce, and therefore it could be considered controversial. Still, existing reports clearly indicate that selected patients with severe asthmatic attacks can benefit from a carefully and closely monitored trial of NIV.¹

 

  • Pneumonia: NIV for patients with severe acute respiratory failure (ARF) due to community-acquired pneumonia (CAP) is controversial. It has to be noted that risk factors for NIV failure in these patients are not well known. Carillo et al. assessed the outcome of those patients and concluded that successful NIV was strongly associated with better survival in patients with ARF due to pneumonia. However, if there are signs of NIV failure, intubations must not be delayed.²

 

  • Acute respiratory distress syndrome (ARDS): Hess et al. suggest that NIV should be used very cautiously, and perhaps not at all, in patients with ARDS who have shock, metabolic acidosis, or profound hypoxemia.³

 

In these patients close monitoring is mandatory. The clinical team must be prepared to immediately intubate the patient and initiate invasive ventilation in patients who fail noninvasive ventilation.

 

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Predictors of failure for NIV

COPD exacerbation

 

  • Arterial blood gases at 2 hrs
  • Breathing frequency at 2 hrs  
  • If pH does NOT improve ≥ 7.25 and/or respiratory rate is still ≥ 35 breath/min then rate of NIV failure is very high
  • SAPS II > 29 at admission

Cardiogenic pulmonary edema

 

  • At admission
  • pH < 7.25  
  • Acute myocardial infarction  
  • Hypercapnia  
  • Ejection fraction < 30%  
  • Blood pressure < 140 mmHg

Acute hypoxic respiratory failure

 

  • SAPS II > 34 at enrolment
  • PaO2/FiO2 < 175 after 1 hr of NIV

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Sources

 

1: Soroksky ,A., Klinowski, E., Ilgyev, E., Mizrachi, A., Miller, A., Yehuda, B., Shpirer, I., Leonov, Y. Noninvasive positive pressure ventilation in acute asthmatic attack. Eur Respir Rev 2010;19(115): p. 39-45.

 

2: Carrillo, A., Gonzalez-Diaz, G., Ferrer, M., Martinez-Quintana, ME., Lopez-Martinez, A., Llamas, N., et al: Non-invasive ventilation in community-acquired pneumonia and severe acute respiratory failure. Intensive Care Med 2012;38(3): p. 458-466

 

3: Hess D. Noninvasive Ventilation for Acute Respiratory Failure, Respiratory Care (2013), Vol 50, No 6: p.950-972

 

4: Nava, S., Ceriana, P.: Causes of failure of non-invasive ventilation, Respir Care (2004): 49: p. 295-303

 

5: Confalorieri, M., Garuti, G., Cattaruzza, MS., et al. A chart of failure risk for non-invasive ventilation in patients with COPD exacerbation. EUR Respir J (2005): 25: p. 348-355

 

6: Masip, J., Montzerrat, JP., Parejo, MS., et al. Risk factors for intubation as a guide for noninvasive ventilation in patients with severe acute cardiogenic pulmonary edema. Intensive Care Med (2003): 29: p. 1921-1928

 

7: Antonelli, M., Conti, G., Esquinas, A., et al. A multiple-center survey on the use in clinical practice of noninvasive ventilation as a first-line intervention for acute respiratory distress syndrome. Crit Care med (2007): 35: p. 18-25

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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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