Patient Care

What Are the Clinical Indications for Noninvasive Positive Pressure Ventilation?

KEY Points

  • NPPV is a modality that assists ventilation by delivering positive expiratory and/or inspiratory pressures without the use of an endotracheal tube. NPPV use avoids the morbidity and mortality associated with endotracheal intubation.
  • Good candidates for NPPV include patients with respiratory distress (including tachypnea or dyspnea), hypercarbia, or hypoxia who are able to protect the airway, tolerate the mask, manage secretions, and are hemodynamically stable.
  • NPPV has been shown to be beneficial in moderate to severe COPD with hypercarbia and respiratory acidosis, cardiogenic pulmonary edema, pulmonary infections in immunosuppressed patients, and can be used as a bridge after extubation in COPD patients.
  • Efficacy data is limited and heterogeneous for patients with asthma exacerbation or pneumonia, for post-surgical patients, in those undergoing bronchoscopy, and in those with ALI/ARDS.
  • There is no evidence for NPPV in extubation failure, though it may facilitate early extubation and prevention of extubation failure in COPD patients.

Additional Reading

  • Liesching T, Kwok H, Hill N. Acute applications of noninvasive positive pressure ventilation. Chest. 2003; 124:699-713.
  • Keenan S, Sinuff T, Burns K, et al. Clinical practice guidelines for the use of noninvasive positive pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting. CMAJ. 2001;183:E195-E214
  • American Thoracic Society. International Consensus Confer-ences in Intensive Care Medicine: Noninvasive Positive Pressure Ventilation in Acute Respiratory Failure. Am J Respir Crit Care Med. 2001;163:283-291.

References

  1. Ambrosino N, Vagheggini G. Noninvasive positive pressure ventilation in the acute care setting: where are we? Euro Resp J. 2008;31:874-856.
  2. American Thoracic Society. International Consensus Conferences in Intensive Care Medicine: Noninvasive Positive Pressure Ventilation in Acute Respiratory Failure. Am J Respir Crit Care Med. 2001;163:283-291.
  3. Liesching T, Kwok H, Hill N. Acute applications of noninvasive positive pressure ventilation. Chest. 2003;124:699-713.
  4. Keenan S, Sinuff T, Burns K, et al. Clinical practice guidelines for the use of noninvasive positive pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting. CMAJ. 2001;183:E195-E214.
  5. Lightowler J, Wedzicha J, Elliot M, Ram F. Noninvasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. BMJ. 2003;326:185.
  6. Quon B, Gan W, Sin D. Contemporary management of acute exacerbations of COPD: a systematic review of the metaanalysis. Chest. 2008;133:756-766.
  7. Keenan S, Sinuff T, Cook D, Hill, N. Which patients with acute exacerbation of chronic obstructive pulmonary disease benefit from noninvasive positive pressure ventilation? Ann Intern Med. 2003;138:861-870.
  8. Scala R, Naldi M, Archinucci I, Conigilo G, Nava S. Noninvasive positive pressure ventilation in patients with acute exacerbations of COPD and varying levels of consciousness. Chest. 2005;128:1657-1666.
  9. Masip J, Roque M, Sanchez B, Fernandez R, Subirana M, Exposito J. Noninvasive ventilation in acute cardiogenic pulmonary edema. JAMA. 2005;294:3124-3130.
  10. Peter J, Moran J, Phillips-Hughes J, Graham P, Bersten A. Effect of non-invasive positive pressure ventilation (NIPPV) on mortality in patients with acute cardiogenic pulmonary oedema: a meta-anaylsis. Lancet. 2006;367:1155-1163.
  11. Weng C, Zhao Y, Liu Q, et al. Meta-analysis: noninvasive ventilation in acute cardiogenic pulmonary edema. Ann Intern Med. 2010;152:560-600.
  12. Keenan S, Sinuff T, Cook D, Hill N. Does noninvasive positive pressure ventilation improve outcome in acute hypoxemic respiratory failure? A systematic review. Crit Care Med. 2004;32:2516-2523.
  13. Esteban A, Frutos-Vivar F, Fergusun N, et al. Noninvasive positive pressure ventilation for respiratory failure after extubation. N Engl J Med. 2004;350:2452-2460.
  14. Nava S, Ambrosino N, Clinie E, et al. Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease: a randomized, controlled trial. Ann Intern Med. 1998;128:721-728.
  15. Grault C, Daudenthun I, Chevron V, et al. Noninvasive ventilation as a systematic extubation and weaning technique in acute on chronic respiratory failure: a prospective, randomized controlled study. Am J Respir Crit Care Med. 1999;160:86-92.
  16. Hilbert G, Gruson D, Vargas F, et al. Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med. 2001;344:481-487.
  17. Ram FSF, Wellington SR, Rowe BH, Wedzicha JA. Non-invasive positive pressure ventilation for treatment of respiratory failure due to severe acute exacerbations of asthma. Cochrane Database of Systematic Reviews. 2005, Issue 3.
  18. Antonelli M, Conti G, Rocco M, et al. Noninvasive positive pressure ventilation vs. conventional oxygen supplementation in hypoxemic patients undergoing diagnostic bronchoscopy. Chest. 2002;121:1149-1154.
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