Noninvasive mechanical ventilation in acute hypoxemic respiratory failure

Abstract

Noninvasive mechanical ventilation is widely used for acute respiratory failure in a variety of etiologies. The recommended specific conditions were the exacerbation of chronic obstructive pulmonary disease, cardiogenic pulmonary edema, de novo acute hypoxemic respiratory failure, immunocompromized pneumonia, palliation, postoperative period, weaning and postextubation. Pneumonia and acute respiratory distress syndrome are common causes of acute hypoxemic respiratory failure. Noninvasive mechanical ventilation failure is high in this disease group compared to acute hypercapnic respiratory failure. Noninvasive mechanical ventilation can be recommended in patients with mild even in moderate acute respiratory distress syndrome and not in patients with severe acute respiratory distress syndrome. Due to insufficient evidence in patients with pneumonia and acute respiratory distress syndrome, no recommendation can be given for routine use of noninvasive mechanical ventilation. Although some patients benefit from noninvasive mechanical ventilation, they should be used by a team experienced on noninvasive mechanical ventilation in pneumonia and early acute respiratory distress syndrome. A skilled team, proper place, patient and devices can optimize prognosis. There should be a particular attention to shock, multiorgan failure and change of consciousness. Patient selection should be made correctly, considering that mortality can be seen in case of delayed intubation.