Noninvasive ventilation for acute respiratory failure.
OBJECTIVE
This review critically examines recent literature related to applications of noninvasive ventilation in the acute setting.


RESULTS
Recent articles have strengthened the evidence supporting the use of noninvasive ventilation for patients with cardiogenic pulmonary edema and exacerbation of severe chronic pulmonary obstructive disease. In the former, however, it remains unclear whether noninvasive ventilation offers any significant advantages over continuous positive airway pressure. The rate of myocardial infarction seems to be no higher when patients with cardiogenic pulmonary edema are treated with noninvasive ventilation rather than continuous positive airway pressure, although caution is still advised in patients with acute coronary syndromes. Noninvasive ventilation also does not seem to increase the risk of dissemination of severe acute respiratory syndrome to health care workers as long as strict isolation procedures are used. Noninvasive ventilation facilitates weaning in patients with chronic obstructive pulmonary disease but should not be used routinely to treat extubation failure, and necessary intubation should not be delayed. Guidelines for the use of noninvasive ventilation can alter caregivers' behavior but have not been clearly shown to improve outcomes. Outcomes do seem to improve, however, as caregivers acquire experience with the technique.


CONCLUSIONS
The recent literature has refined some of the current indications for noninvasive ventilation in the acute-care setting, including chronic pulmonary obstructive disease and cardiogenic pulmonary edema. Guidelines for use are now being developed, and outcomes seem to be improving, partly as a consequence of greater caregiver experience and possibly related to technologic advances.
Majid
Adnan
A
Division of Pulmonary, Critical Care and Sleep Medicine, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA.
Hill
Nicholas S
NS
D000208:Acute Disease; D001249:Asthma / Q000150:complications / Q000628:therapy; D004867:Equipment Design; D006801:Humans; D008397:Masks; D011014:Pneumonia / Q000150:complications / Q000628:therapy; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000628:therapy; D011654:Pulmonary Edema / Q000150:complications / Q000628:therapy; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D012138:Respiratory Therapy / Q000379:methods* / Q000592:standards; D015300:Ventilator Weaning / Q000379:methods