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A Journal on Diseases of the Respiratory System
Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Minerva Pneumologica 2013 March;52(1):39-53
Common mistakes leading to NIV failure
Bayarassou A. H., Storre J. H., Windisch W.
Department of Pneumology, Clinic of Cologne, University of Witten/Herdecke, Köln, Germany
In the acute setting non-invasive positive pressure ventilation (NPPV) is aimed at avoiding intubation and intubation-related complications. In some conditions such as acute exacerbation of chronic obstructive pulmonary disease the avoidance of intubation gained by NPPV has been shown to substantially improve intensive care unit (ICU) survival. However, NPPV is typically performed in conscious patients and might eventually fail as a reason of intolerance or inefficiency. In this scenario intubation occurs possibly too late, which negatively impacts on prognosis. Therefore, the issue of NPPV failure is acknowledged to be of major importance. In general, two global reasons can be responsible for NPPV failure, firstly, predefined conditions independent from staff handling, and secondly, common treatment mistakes. Predefined conditions are unchangeable and primarily refer to specific underlying conditions (e.g. hypoxemic versus hypercapnic respiratory failure), disease severity, and complications related to the circumstances of the patient. In contrast, common treatment mistakes are clearly related to the handling of these patients. There are several areas, in which the specific setting of the unit or also staff members’ handling can contribute to NPPV failure. These include the application of NPPV despite existing contraindications or even incorrect indications, low staff experience/expertise, disadvantageous locations and monitoring systems used for NPPV application, failures when choosing the type of ventilator, the specific ventilator modes and the individual ventilator settings, the choice of non-fitting interfaces, and finally, the application of not enough or too much sedation. The present article focuses on all of the listed areas related to common treatment mistakes possibly leading to NPPV failure. Thereby, practical advice on how to avoid treatment mistakes is provided.