Noninvasive ventilation in acute respiratory failure: which recipe for success?

European Respiratory Review : an Official Journal of the European Respiratory Society
Raffaele Scala, Lara Pisani

Abstract

Noninvasive positive-pressure ventilation (NPPV) to treat acute respiratory failure has expanded tremendously over the world in terms of the spectrum of diseases that can be successfully managed, the locations of its application and achievable goals.The turning point for the successful expansion of NPPV is its ability to achieve the same physiological effects as invasive mechanical ventilation with the avoidance of the life-threatening risks correlated with the use of an artificial airway.Cardiorespiratory arrest, extreme psychomotor agitation, severe haemodynamic instability, nonhypercapnic coma and multiple organ failure are absolute contraindications for NPPV. Moreover, pitfalls of NPPV reduce its rate of success; consistently, a clear plan of what to do in case of NPPV failure should be considered, especially for patients managed in unprotected setting. NPPV failure is likely to be reduced by the application of integrated therapeutic tools in selected patients handled by expert teams.In conclusion, NPPV has to be considered as a rational art and not just as an application of science, which requires the ability of clinicians to both choose case-by-case the best "ingredients" for a "successful recipe" (i.e. patient selection,...Continue Reading

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Oct 28, 2020·Perioperative Medicine·Federico PiccioniUNKNOWN AIPO, Associazione Italiana Pneumologi Ospedalieri; SIAARTI, Società Italiana di Anestesia Analgesia Rianimazione Terapia In
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