REVIEWS  CRITICAL AND INTENSIVE THERAPY Free access

Minerva Anestesiologica 2000 October;66(10):697-712

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: Italian

Positive pressure non invasive mechanical ventilation in acute respiratory failure

Scala R.

ASL n. 8 - Arezzo U.O. di Pneumologia

­Known for two cen­tu­ries, pos­i­tive pres­sure non inva­sive mechan­i­cal ven­ti­la­tion (VMNPP) has ­been wide­ly ­applied in ­acute res­pir­a­to­ry fail­ure (IRA) ­only in the ­last ten ­years. The ­fact ­that ­VMNPP is ­able to ­improve gas ­exchange by avoid­ing endo­tra­cheal intu­ba­tion and its com­pli­ca­tions is the ­most attrac­tive ­aspect in ­both gen­er­al and res­pir­a­to­ry inten­sive ­care ­units and in the res­pir­a­to­ry ­ward. Char­ac­ter­is­tics of ­VMNPP (inter­face, ven­ti­la­tor and modal­ity of ven­ti­la­tion), the ­side ­where it is per­formed as ­well as sever­ity of IRA, under­ly­ing dis­ease, and the ­team’s expe­ri­ence are impor­tant fac­tors ­which influ­ence out­come. The addi­tion of ­VMNPP to con­ven­tion­al med­i­cal ther­a­py reduc­es the ­need for IE, mor­tal­ity and hos­pi­tal­isa­tion in a select­ed pop­u­la­tion of ­BPCO ­patients in IRA. As ­there are no avail­able ­data for com­par­i­son ­between inva­sive mechan­i­cal ven­ti­la­tion (VMI) and ­VMNPP, the lat­ter has not to be con­sid­ered as an alter­na­tive to VMI but ­able to pre­vent it and, ­even if ­VMNPP ­fails, it may be ­used as a wean­ing tech­nique. In IRA due to oth­er ­than ­BPCO dis­eas­es ­VMNPP ­seems not to be ­more effec­tive ­than stan­dard treat­ment in avoid­ing IE but it may ­give effi­cient sup­port ­with few­er com­pli­ca­tions as com­pared to VMI. ­Acute car­di­o­gen­ic pul­mo­nary ede­ma and “ter­mi­nal” dis­eas­es rep­re­sent ­some of the ­most inter­est­ing appli­ca­tion ­fields of ­VMNPP in non-­BPCO ­patients. Accord­ing to the lat­est lit­er­a­ture ­data, in ­this ­review his­to­ry, tech­nique, advan­tag­es, lim­its, indi­ca­tions, nurs­ing and ­cost of ­VMNPP are exam­ined.