Noninvasive ventilation for patients with acute lung injury or acute respiratory distress syndrome.
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, P(aO(2))/F(IO(2)) < 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.
Pneumologia e Terapia Intensiva Respiratoria, Dipartimento Cardio-Toraco-Vascolare, Policlinico Sant' Orsola-Malpighi, Bologna, Italy. stefano.nava@aosp.bo.it
Stefano
S
Nava
Ania
A
Schreiber
Guido
G
Domenighetti
D055371:Acute Lung Injury / Q000628:therapy*; D000328:Adult; D016638:Critical Illness; D006801:Humans; D016867:Immunocompromised Host; D007442:Intubation, Intratracheal; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D016896:Treatment Outcome