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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):1-14


language: English

NIV applications for acute respiratory care: NIV for acute hypercapnic patients

Riera J. 1, 2, Ferrer J. 2, 3, 4

1 Critical Care Department, Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Barcelona, Spain; 2 Department of Medicine, Barcelona Autonomous University, Barcelona, Spain; 3 Department of Pneumology, Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Barcelona, Spain; 4 Centro de Investigación Biomédica en Red. Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain


There’s high quality evidence about the benefits of using noninvasive ventilation (NIV) in patients suffering acute hypercapnic respiratory failure (AHRF). The acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the most common cause of AHRF. A very important point is the early and precise identification of those patients with AHRF who could clearly benefit from the application of NIV and those ventilated subjects in whom the technique is failing. This accurate selection could significantly improve NIV success. Another imperative condition to achieve NIV success is the patient’s tolerance to the technique. Choosing an appropriate interface, a suitable and effective mode of ventilation and a correct air humidification could contribute to a better adherence to NIV by the patient. The remarkable good tolerance of the high-flow nasal cannula system and its effects on the respiratory function makes it an optional mode to ventilate hypercapnic patients. Moreover, the recently simplified extracorporeal systems may be associated with NIV in order to avoid invasive ventilation. In this paper, the abovementioned issues are reviewed on the bases of the available scientific evidence. The review is firstly focused on evidence-based indications and contraindications of NIV for patients with AHRF, continues with an overview of important points associated to NIV application and ends with new therapies linked to it.

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