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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 2015 September;54(3):129-55
NIV: therapeutic methods beyond standard ventilation
Menadue C., Hollier C. A.
Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
Positive pressure non-invasive ventilation (NIV) delivered to the patient’s upper airway using a mask or similar device is a standard of care for many patients with chronic hypercapnic respiratory failure during sleep, and in the hospital setting for people with acute respiratory failure secondary to an acute exacerbation of chronic obstructive pulmonary disease or acute cardiogenic pulmonary oedema. Since the first descriptions of modern NIV in the literature in 1987, the use of NIV has proliferated and the context in which NIV is used has expanded beyond these standard applications. The use of NIV during and after diagnostic and surgical interventions allows access to a wider range of treatments for patients who may otherwise be deemed too high risk. NIV during exercise may allow people with chronic obstructive pulmonary disease to exercise at a higher intensity and achieve greater improvements in exercise capacity. Prehospital continuous positive airway pressure delivered by experienced providers decreases intubation rates and mortality in people with acute respiratory failure compared with standard medical therapy, while the role of prehospital NIV is uncertain. NIV is an effective adjunct to airway clearance techniques in children and adults with cystic fibrosis during a single treatment session. The use of continuous NIV is a safe alternative to tracheal ventilation in individuals who are ventilator dependent and appears to prolong survival in patients with Duchenne muscular dystrophy, provided strategies to augment cough are also implemented. The present review will outline the rationale and evidence base for the use of NIV in these non-standard contexts.