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21 Non-invasive ventilation
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Published:February 2021
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This version:June 2023
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Abstract
During the last 30 years, the use of non-invasive ventilation has grown substantially. Non-invasive ventilation refers to the delivery of positive pressure to the lungs without endotracheal intubation and plays a significant role in the treatment of patients with acute respiratory failure and in the domiciliary management of some chronic respiratory and sleep disorders. In the intensive and acute care setting, the primary aim of non-invasive ventilation is to avoid intubation, and it is mainly used in patients with chronic obstructive pulmonary disease exacerbations, acute cardiogenic pulmonary oedema, immunocompromised or in the context of weaning, and, more recently, in some patients with hypoxaemic acute respiratory failure. The principal techniques are continuous positive airway pressure, bilevel pressure support ventilation and more recently, high flow nasal cannula. Whereas non-invasive pressure support ventilation requires a ventilator, the other two techniques are simpler and can be easily used in non-equipped areas by less experienced teams, including the pre-hospital setting. The success of non-invasive ventilation is related to the appropriate timing, selection of patients, techniques, and interfaces, as well as adequate monitoring and adaptation to the patients’ demand.
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