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Research ArticleConference Proceedings

The Physiologic Effects of Noninvasive Ventilation

Richard H Kallet and Janet V Diaz
Respiratory Care January 2009, 54 (1) 102-115;
Richard H Kallet
Department of Anesthesia
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  • For correspondence: [email protected]
Janet V Diaz
Department of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco General Hospital, San Francisco, California
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Abstract

The physiologic effects of noninvasive ventilation (NIV) on work of breathing (WOB) and breathing pattern, respiratory-system mechanics, and hemodynamic function were examined via a literature review of clinical studies done between 1990 and 2009. Forty-one relevant studies were found; the majority examined patients with chronic obstructive pulmonary disease, whereas some also included patients with restrictive chest-wall disease or acute hypoxic respiratory failure. NIV reduced WOB in direct proportion to the level of inspiratory pressure-assist, and also by the ability of applied positive end-expiratory pressure (PEEP) to counter intrinsic PEEP. In general an inspiratory pressure-support level of 15 cm H2O and a PEEP of 5 cm H2O reduced most measures of WOB and inspiratory effort toward normal. When set to the same level of inspiratory pressure-assist, both pressure-support ventilation and proportional-assist ventilation effected comparable reductions in WOB. At high levels of inspiratory pressure-assist, NIV consistently increased dynamic lung compliance and tidal volume, and improved arterial blood gases. The hemodynamic effects of NIV are dependent upon the interplay between the type of mask, the level of inspiratory pressure-assist and PEEP, and the disease state. In general, patients with chronic obstructive pulmonary disease have a higher tendency toward decreased cardiac output at high levels of inspiratory pressureassist, compared to those with acute lung injury.

  • noninvasive ventilation
  • work of breathing
  • respiratory-system mechanics
  • pressure-support ventilation
  • proportional-assist ventilation
  • breathing pattern

Footnotes

  • Correspondence: Richard H Kallet MSc RRT FAARC, Respiratory Care Services, San Francisco General Hospital, NH:GA-2, 1001 Potrero Avenue, San Francisco CA 94110. E-mail: rkallet{at}sfghsom.ucsf.edu.
  • Mr Kallet presented a version of this paper at the 42nd Respiratory Care Journal Conference, “Noninvasive Ventilation in Acute Care: Controversies and Emerging Concepts,” held March 7-9, 2008, in Cancún, México.

  • The authors report no conflicts of interest related to the content of this paper.

  • Copyright © 2009 by Daedalus Enterprises Inc.
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Respiratory Care: 54 (1)
Respiratory Care
Vol. 54, Issue 1
1 Jan 2009
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The Physiologic Effects of Noninvasive Ventilation
Richard H Kallet, Janet V Diaz
Respiratory Care Jan 2009, 54 (1) 102-115;

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Richard H Kallet, Janet V Diaz
Respiratory Care Jan 2009, 54 (1) 102-115;
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Keywords

  • noninvasive ventilation
  • work of breathing
  • respiratory-system mechanics
  • pressure-support ventilation
  • proportional-assist ventilation
  • breathing pattern

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