Noninvasive mechanical ventilation

Abstract

Patients with acute respiratory failure have been treated with intubation and mechanical ventilation for treatment of hypoxemia, hypoventilation and respiratory distress. However, tracheal intubation is associated with several complications, use of sedatives and prolongation of hospitalization time. Noninvasive ventilation provides ventilatory assistance without the need of artificial airway, with the use of masks in patient-ventilator interface. Its use in clinical practice has increased over the last 20 years as well as the availability of technology resources for its implementation. Currently, it is considered first-line treatment for acute respiratory insufficiency. Similar to invasive ventilation, noninvasive ventilation can reduce the work of breathing and respiratory rate, increase tidal volume, improve gas exchange, dyspnea, promote rest of respiratory muscles and patient comfort. Its indication is well established in chronic obstructive pulmonary disease, cardiogenic pulmonary edema and in immunosuppressed patients. Other clinical applications should be carefully evaluated as a delay in the intubation can increase mortality in these patients. Some protocols are available in the literature but the clinical judgment and knowledge of available resources by well-trained staff are key to the success of noninvasive ventilation. Likewise, choosing the correct interface, ventilation mode and monitoring in intensive care unit optimize patient comfort and patient-ventilator interaction with better clinical outcomes. This article aims to review the latest literature on indications and clinical use of noninvasive ventilation.