From the Guidelines
Contraindications for noninvasive positive pressure ventilation (NPPV) include emesis, inability to protect airway, and need for urgent intubation, as well as respiratory arrest, cardiovascular instability, impaired mental status, and recent facial or gastro-oesophageal surgery. These conditions are considered absolute contraindications due to the increased risk of complications, such as aspiration, barotrauma, or delayed intubation 1.
Key Contraindications
- Respiratory arrest
- Inability to protect airway
- Need for urgent intubation
- Emesis
- Cardiovascular instability
- Impaired mental status
- Recent facial or gastro-oesophageal surgery
- Craniofacial trauma and/or fixed naso-pharyngeal abnormality
- Burns
- Extreme obesity When considering NPPV, it is essential to weigh the potential benefits against the risks and to maintain readiness to escalate to invasive ventilation if the patient's condition deteriorates or if NPPV proves ineffective 1. The decision to use NPPV requires careful clinical judgment, taking into account the patient's overall clinical status and the presence of any contraindications 1.
From the Research
Contraindications for Noninvasive Positive Pressure Ventilation
The following are contraindications for noninvasive positive pressure ventilation (NPPV):
- Cardiac or respiratory arrest 2, 3
- Nonrespiratory organ failure, such as severe encephalopathy, severe gastrointestinal bleeding, or hemodynamic instability with or without unstable cardiac angina 2, 3
- Facial surgery or trauma 2
- Upper-airway obstruction 2
- Inability to protect the airway and/or high risk of aspiration 2
- Inability to clear secretions 2
- Extreme psychomotor agitation 3
- Severe haemodynamic instability 3
- Nonhypercapnic coma 3
- Multiple organ failure 3
Additional Considerations
It is essential to carefully evaluate patients for these contraindications before initiating NPPV, as the presence of any of these conditions may necessitate alternative treatment approaches, such as invasive mechanical ventilation 2, 3.