Overview, Indications, And Contraindications for Noninvasive Ventilation From Emedicine.medscape

Noninvasive ventilation is also called noninvasive positive pressure ventilation (NIPPV).

Historically, noninvasive negative pressure ventilation was used in the polio epidemic (the iron lung) but noninvasive ventilation currently refers to NIPPV.

This section of the post consists of an Overview of Nonivasive Ventilation excerpted from the web page  Noninvasive Ventilation (Overview) [The entire article can be accessed starting with this link]:

Noninvasive ventilation (NIV) refers to the administration of ventilatory support without using an invasive artificial airway (endotracheal tube or tracheostomy tube). The use of noninvasive ventilation (see the video below) has markedly increased over the past two decades, and noninvasive ventilation has now become an integral tool in the management of both acute and chronic respiratory failure, in both the home setting and in the critical care unit. Noninvasive ventilation has been used as a replacement for invasive ventilation, and its flexibility also allows it to be a valuable complement in patient management. Its use in acute respiratory failure is well accepted and widespread. It is the focus of this review. The role of noninvasive ventilation in those with chronic respiratory failure is not as clear and remains to be defined.

This section of the post concerns  Indications And Contraindications for Noninvasive Ventilation and is excerpted from the web page Noninvasive Ventilation (General Considerations)  emedicine.medscape.com.

Absolute contraindications are as follows:

  • Coma
  • Cardiac arrest
  • Respiratory arrest
  • Any condition requiring immediate intubation

Other contraindications (rare exceptions) are as follows:

  • Cardiac instability – Shock and need for pressor support, ventricular dysrhythmias, complicated acute myocardial infarction
  • GI bleeding – Intractable emesis and/or uncontrollable bleeding
  • Inability to protect airway – Impaired cough or swallowing, poor clearance of secretions, depressed sensorium and lethargy
  • Status epilepticus
  • Potential for upper airway obstruction – Extensive head and neck tumors, any other tumor with extrinsic airway compression, angioedema or anaphylaxis causing airway compromise

Patient inclusion criteria are as follows:

  • Patient cooperation (an essential component that excludes agitated, belligerent, or comatose patients)
  • Dyspnea (moderate to severe, but short of respiratory failure)
  • Tachypnea (>24 breaths/min)
  • Increased work of breathing (accessory muscle use, pursed-lips breathing)
  • Hypercapnic respiratory acidosis (pH range 7.10-7.35)
  • Hypoxemia (PaO 2/FIO 2 <200 mm Hg, best in rapidly reversible causes of hypoxemia)

Not all respiratory conditions are suitable for treatment with noninvasive ventilation.

Suitable clinical conditions for noninvasive ventilation (most patients) are as follows:

  • Chronic obstructive pulmonary disease
  • Cardiogenic pulmonary edema

Suitable clinical conditions for noninvasive ventilation (selected patients) are as follows:

  • After discontinuation of mechanical ventilation (COPD)
  • Immunocompromised state (known cause of infiltrates)
  • Postoperative respiratory distress and respiratory failure
  • Do-not-intubate status
  • Neuromuscular respiratory failure (better in chronic than acute; avoid if upper airway issues)
  • Decompensated obstructive sleep apnea/cor pulmonale
  • Cystic fibrosis
  • Mild Pneumocystic carinii pneumonia
  • Rib fractures

Use with caution in the following clinical conditions:

  • Idiopathic pulmonary fibrosis (exacerbation)
  • Acute respiratory distress syndrome (consider helmet ventilation)

See also:

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