From the Guidelines
Non-invasive ventilation (NIV) is indicated for several respiratory conditions, including acute exacerbations of COPD, acute cardiogenic pulmonary edema, and respiratory failure in immunocompromised patients, as stated in the official ERS/ATS clinical practice guidelines 1. The primary indications for NIV include:
- Acute exacerbations of COPD
- Acute cardiogenic pulmonary edema
- Respiratory failure in immunocompromised patients
- Neuromuscular diseases
- Obesity hypoventilation syndrome
- Weaning strategy from mechanical ventilation For COPD exacerbations, NIV reduces work of breathing, improves gas exchange, and decreases intubation rates and mortality, as supported by studies 1. In cardiogenic pulmonary edema, NIV helps by increasing intrathoracic pressure, reducing preload and afterload, and improving oxygenation. NIV settings typically start with IPAP of 8-12 cmH2O and EPAP of 3-5 cmH2O, titrated based on patient response. Contraindications include:
- Respiratory arrest
- Hemodynamic instability
- Facial trauma
- Recent upper airway or gastrointestinal surgery
- Inability to protect the airway
- Excessive secretions
- Patient intolerance Close monitoring is essential during NIV therapy, with assessment of respiratory rate, oxygen saturation, and patient comfort to determine effectiveness and need for escalation to invasive ventilation if the patient fails to improve, as recommended by the European Respiratory Society/American Thoracic Society guidelines 1.
From the Research
Indications for Non-Invasive Ventilation (NIV)
- Severe acute exacerbation of chronic obstructive pulmonary disease (COPD) with pH < 7.35 and relative hypercarbia 2
- Acute cardiogenic pulmonary edema 2, 3, 4
- Respiratory failure in immunocompromised patients 2
- Chest trauma patients 2
- Hypoxaemic respiratory failure occurring without prior chronic respiratory disease (De novo respiratory failure), although the benefits of NIV in this condition are not as evident 2
Benefits of NIV
- Decreased mortality 5, 6
- Decreased need for endotracheal intubation 3, 5, 6
- Reduced length of hospital stay 5, 6
- Improved gas exchange and symptoms 4
- Reduced incidence of complications unrelated to NIV 6
- Avoidance of reintubation and decrease in the length of invasive mechanical ventilation 4