title: Noninvasive ventilation for patients with hypoxemic acute respiratory failure.
abstract: Noninvasive ventilation (NIV) has an established efficacy to improve gas exchange and reduce the work of breathing in patients with hypoxemic acute respiratory failure. The clinical efficacy in terms of meaningful outcome is less clear and depends very much on patient selection and assessment of the risks of the technique. The potential risks include an insufficient reduction of the oxygen consumption of the respiratory muscles in case of shock, an excessive increase in tidal volume in case of lung injury, and a risk of delayed or emergent intubation. With a careful selection of patients and a rapid decision regarding the need for intubation in case of failure, great benefits can be offered to patients. Emerging indications include its use in patients with treatment limitations, in the postoperative period, and in patients with immunosuppression. This last indication will necessitate reappraisal because the prognosis of the conditions associated with immunosuppression has improved over the years. In all cases, there is both a time window and a severity window for NIV to work, after which delaying endotracheal intubation may worsen outcome. The preventive use of NIV seems promising in this setting but needs more research. An emerging interesting new option is the use of high flow humidified oxygen, which seems to be intermediate between oxygen alone and NIV.
authors.affiliation: Keenan Research Centre and Critical Care Department, Saint Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Laurent
authors.initials: L
authors.lastname: Brochard
authors.affiliation: Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, Switzerland.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Lefebvre
authors.affiliation: Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, Switzerland.
authors.forename: Ricardo Luiz
authors.initials: RL
authors.lastname: Cordioli
authors.affiliation: Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, Switzerland.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Akoumianaki
authors.affiliation: Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, Switzerland.
authors.forename: Jean-Christophe M
authors.initials: JC
authors.lastname: Richard
mesh_terms: D000208:Acute Disease; D006801:Humans; D000860:Hypoxia / Q000503:physiopathology / Q000628:therapy*; D007442:Intubation, Intratracheal / Q000379:methods; D063087:Noninvasive Ventilation / Q000009:adverse effects / Q000379:methods*; D010101:Oxygen Consumption; D018579:Patient Selection; D011659:Pulmonary Gas Exchange; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000628:therapy*; D012720:Severity of Illness Index; D013990:Tidal Volume; D013997:Time Factors