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:
- Postoperative respiratory failure: See more under NIV in post-operative patients
- 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.