RT Journal Article
SR Electronic
T1 Noninvasive Ventilation for Patients With Acute Lung Injury or Acute Respiratory Distress Syndrome
JF Respiratory Care
FD American Association for Respiratory Care
SP 1583
OP 1588
DO 10.4187/respcare.01209
VO 56
IS 10
A1 Stefano Nava
A1 Ania Schreiber
A1 Guido Domenighetti
YR 2011
UL http://rc.rcjournal.com/content/56/10/1583.abstract
AB Few studies have been performed on noninvasive ventilation (NIV) to treat hypoxic acute respiratory failure in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). The outcomes of these patients, for whom endotracheal intubation is not mandatory, depend on the degree of hypoxia, the presence of comorbidities and complications, and their illness severity. The use of NIV as an alternative to invasive ventilation in severely hypoxemic patients with ARDS (ie, PaO2/FIO2 < 200) is not generally advisable and should be limited to hemodynamically stable patients who can be closely monitored in an intensive care unit by highly skilled staff. Early NIV application may be extremely helpful in immunocompromised patients with pulmonary infiltrates, in whom intubation dramatically increases the risk of infection, pneumonia, and death. The use of NIV in patients with severe acute respiratory syndrome and other airborne diseases has generated debate, despite encouraging clinical results, mainly because of safety issues. Overall, the high rate of NIV failure suggests a cautious approach to NIV use in patients with ALI/ARDS, including early initiation, intensive monitoring, and prompt intubation if signs of NIV failure emerge.