title: Noninvasive ventilation for acute respiratory distress syndrome: the importance of ventilator settings.
abstract: Noninvasive ventilation (NIV) is commonly used to prevent endotracheal intubation in patients with acute respiratory distress syndrome (ARDS). Patients with hypoxemic acute respiratory failure who fail an NIV trial carry a worse prognosis as compared to those who succeed. Additional factors are also knowingly associated with worse outcomes: higher values of ICU severity score, presence of severe sepsis, and lower ratio of arterial oxygen tension to fraction of inspired oxygen. However, it is still unclear whether NIV failure is responsible for the worse prognosis or if it is merely a marker of the underlying disease severity. There is therefore an ongoing debate as to whether and which ARDS patients are good candidates to an NIV trial. In a recent paper published inJAMA, "Effect of Noninvasive Ventilation Delivered by Helmet vs. Face Mask on the Rate of Endotracheal Intubation in Patients with Acute Respiratory Distress Syndrome: A Randomized Clinical Trial", Patelet al. evaluated ARDS patients submitted to NIV and drew attention to the importance of the NIV interface. We discussed their interesting findings focusing also on the ventilator settings and on the current barriers to lung protective ventilation in ARDS patients during NIV.
authors.affiliation: Respiratory ICU, Pulmonary Division, Heart Institute (INCOR), Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
authors.forename: Mauro R
authors.initials: MR
authors.lastname: Tucci
authors.affiliation: Respiratory ICU, Pulmonary Division, Heart Institute (INCOR), Hospital das Clínicas, University of São Paulo, São Paulo, Brazil; ; Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.
authors.forename: Eduardo L V
authors.initials: EL
authors.lastname: Costa
authors.affiliation: Respiratory ICU, Pulmonary Division, Heart Institute (INCOR), Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
authors.forename: Maria A M
authors.initials: MA
authors.lastname: Nakamura
authors.affiliation: Respiratory ICU, Pulmonary Division, Heart Institute (INCOR), Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
authors.forename: Caio C A
authors.initials: CC
authors.lastname: Morais
keywords: Noninvasive ventilation (NIV); adult; respiratory distress syndrome; respiratory insufficiency