[Non-invasive ventilation as treatment for acute respiratory insufficiency. Essentials from the new S3 guidelines].
BACKGROUND
Scientific evidence is accumulating that non-invasive ventilation (NIV) may be beneficial for different patient groups with acute respiratory insufficiency (ARI). The aim of the new S3 guidelines is to propagate evidence-based knowledge about the indications and limitations of NIV in clinical practice.


METHODS
A total of 28 experts from 12 German medical societies were involved in the process of development of the present guidelines. These experts systematically analyzed approximately 2,900 publications. Finally, the recommendations were discussed and approved in two consensus conferences.


RESULTS
In hypercapnic ARI, NIV reduces the length of stay and mortality during intensive care treatment [grade A recommendation (A)]. Patients with cardiopulmonary edema should be treated with continuous positive airway pressure (CPAP) or NIV (A). For immunocompromized patients with ARI, NIV reduces the mortality (A). In patients with postextubation respiratory failure and during weaning from mechanical ventilation, NIV reduces the risk of reintubation (A). For patients who decline to be ventilated invasively, NIV may be an acceptable alternative (B). Non-invasive ventilation can also successfully be used in pediatric patients with ARI caused by different reasons (C). In acute respiratory distress syndrome (ARDS) NIV cannot generally be recommended because the failure rate is relatively high.


CONCLUSIONS
Non-invasive ventilation is still not as widely implemented in clinical medicine as would be expected on the basis of the scientific literature. The aim of the present guidelines is to further propagate NIV for the treatment of ARI.
Schönhofer
B
B
Abteilung für Pneumologie und internistische Intensivmedizin, Krankenhaus Oststadt - Heidehaus, Klinikum Region Hannover, Podbielskistr. 380, 30659 Hannover, Deutschland. Bernd.Schoenhofer@t-online.de
Kuhlen
R
R
Neumann
P
P
Westhoff
M
M
Berndt
C
C
Sitter
H
H
D000208:Acute Disease; D000328:Adult; D002648:Child; D003245:Consensus Statements as Topic; D045422:Continuous Positive Airway Pressure; D003422:Critical Care; D005858:Germany; D017408:Guidelines as Topic; D017052:Hospital Mortality; D006801:Humans; D006935:Hypercapnia / Q000628:therapy; D016867:Immunocompromised Host; D007902:Length of Stay; D008991:Monitoring, Physiologic; D012121:Respiration, Artificial / Q000592:standards* / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D015300:Ventilator Weaning; D012122:Ventilators, Mechanical / Q000706:statistics & numerical data*