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Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus
Online ISSN 1827-1723
CONTROVERSIES AND UPDATES IN RESPIRATORY MEDICINE
Oscroft N. S., Smith I. E.
Respiratory Support and Sleep Centre, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
Non-invasive ventilation describes the application of either negative pressure to the chest and abdomen or positive pressure to the upper airway to augment ventilation. This is distinct from invasive ventilation that bypasses the upper airway. Non-invasive positive pressure ventilation has the advantage over invasive ventilation of delivering ventilatory support whilst having lower rates of ventilator-associated pneumonia. The methods of application and roles for non-invasive ventilation have changed considerably over the last thirty years with the development of new ventilators and patient interfaces. The evidence base for the use of non-invasive ventilation has grown significantly. Non-invasive ventilation currently plays a role in three main clinical areas: the management of chronic ventilatory failure; acute ventilatory support primarily to reduce the requirement and complications of invasive ventilation and thirdly as a tool to allow timely and safe weaning from invasive ventilation. Many different etiologies may lead to ventilatory failure and whilst the evidence base for non-invasive ventilation is strong in certain conditions in other areas it remains inconclusive. This review examines the roles of non-invasive ventilation in adults and the evidence base behind them and identifies ongoing controversies. Potential areas of development are highlighted including novel patient populations that may benefit from non-invasive ventilation and emerging ventilator technologies.