Optimising the Use of Non-Invasive Ventilation in the Intensive Care Setting

Carl      Horsley; Anthony      Williams

Abstract

Background: Non-invasive ventilation (NIV) has now become an integral part of ventilatory support in the Intensive Care Unit (ICU). There has been much research carried out looking at the pathophysiology of various conditions as well as attempts to define the clinical effects of NIV in various conditions. This article discusses some of the conditions for which NIV has been used in the intensive care setting. It examines some of the underlying pathophysiology as well as clinical research into the effectiveness of NIV for these conditions. Some of the practical issues in the application of NIV are also discussed. Discussion: NIV is indicated as the treatment of choice in respiratory failure due to pulmonary oedema and exacerbations of COPD. There is also significant evidence for its use in the management of pulmonary infection in immunocompromised patients and in managing respiratory failure in patients who cannot be invasively ventilated. The use of NIV in asthma and acute lung injury have been well reported but remain experimental at this stage. Consideration of the underlying pathophysiology helps to explain the reasons why NIV is more useful in some of these conditions and can also be used to guide effective use for an individual patient. Conclusion: The choice of mode of respiratory support, interface and equipment settings will be tailored to the individual patients needs based on clinical experience. In the acute care setting the success of NIV therapies is dependent on patient selections and good nursing care by the clinical team.

Keywords: Non-invasive ventilation, respiratory failure, continuous positive airway pressure, COPD, CPAP, NPPV, Pathophysiology, EELV, PEEP, asthma, Chronic bronchitis, emphysema, hyperinflation, (IPAP), Pulmonary Oedema, hypoxaemia, Severe Acute Respiratory Syndrome, SARS, Obesity, NIV, (HME)