Noninvasive ventilation in patients with hypoxemic acute respiratory failure.
OBJECTIVE
To discuss the recent literature concerning the use of noninvasive ventilation for hypoxemic acute respiratory failure.


RESULTS
The benefits of noninvasive ventilation for patients with hypoxemic acute respiratory failure are unclear. In immunocompromised patients and following thoracic surgery, there is a strong rationale for using noninvasive ventilation to treat acute respiratory failure. Prophylactic continuous positive airway pressure after abdominal or thoracic surgery and prophylactic noninvasive ventilation in patients at risk of extubation failure have proved beneficial. Recent studies show that noninvasive ventilation has a favourable impact in immunocompetent patients with acute lung injury/acute respiratory distress syndrome, but caution is required. In hypoxemic acute respiratory failure after extubation, one study reported excess mortality in patients treated with noninvasive ventilation, possibly related to the delay for intubation. A major issue is avoiding undue noninvasive ventilation prolongation and staying alert for predictors of early noninvasive ventilation failure. Caution, close monitoring, and broad experience are required.


CONCLUSIONS
Hypoxemic acute respiratory failure may benefit from noninvasive ventilation or continuous positive airway pressure, but undue prolongation should be avoided. In postextubation respiratory failure there is no evidence for routine use of noninvasive ventilation.
Lellouche
François
F
Centre de Recherche de l'Hôpital Laval, Soins Intensifs de Chirurgie Cardiaque, Hôpital Laval, Quebec City, Canada. flellouche@free.fr
D000208:Acute Disease; D045422:Continuous Positive Airway Pressure; D006801:Humans; D000860:Hypoxia / Q000628:therapy*; D016867:Immunocompromised Host; D012123:Pulmonary Ventilation; D012131:Respiratory Insufficiency / Q000628:therapy*