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The early use of non-invasive ventilation averts mechanical ventilation and intubation in adult patients that present acute respiratory failures. NIV reduces mortality in such patients. Over the past two decades, NIV has exhibited a tremendous reduction in the mortality of patients that suffer from respiratory failures. The treatment improves gaseous exchange by delivering positive pressure of the airways through a fitted mask rather than a tracheostomy or endotracheal tube. Reduced mortality among patients that adopt NIV treatment is attributed to increased cardiac output and the reduced load of breathing in patients.
The ventilation modes that are used in NIV include CPAP (Continuous Positive Airway Pressure) and BiPAP (Bilateral Positive Airway Pressure). CPAP is responsible for maintenance of a positive airways pressure in the entire respiratory cycle. On the other hand, a further increase in airway pressure is noted during both inspiration and expiration when BiPAP is used (Gray et al, 2009; Keenan et al, 2011; Salman et al, 2010; Agarwal et al, 2009).
Moreover, in patients diagnosed with cardiogenic pulmonary oedema, CPAP provides better results (Antro et al, 2005; Walkey et al, 2012). The comfort of a patient is also improved using NIV following its preservation of airway defense mechanisms such as swallowing and speech (Nava et al, 2006; Kramer et al, 1995). Initiating NIV resolves breathlessness, respiratory distress and metabolic abnormalities. According to Antonneli et al (2007), improved FiO2 and PaO2 were noted in NIV-treated patients within one treatment hour (Antonelli et al, 1998; Antonelli et al, 2007).
The success of NIV treatment is dependent on whether contraindications result or not. As a result, positive outcomes are witnessed in the absence of contraindications. However, in the event of contraindications, the risk of intubation is increased (Gupta et al, 2013). NIV exhibits a failure rate of between 5%-50% depending on the severity of the respiratory infection. NIV is also preferred to mechanical ventilation following its 72% survival rate as compared to 53% rate noted under mechanical ventilation. NIV improvements should target increasing its rate of survival in patients suffering from chronic obstructive respiratory infections.
Humidification can be used to improve NIVs outcomes in patients. This can be achieved through humidification and heating of air to the normal natural levels in the nasopharynx (31OC, 32 mg/L). This enhances the tolerance of a patient by increasing comfort, improving secretion clearance and minimizing airway drying.
References
Agarwal, R., Handa, A., Aggarwal, A.N, Gupta, D., & Behera, D. (2009). Outcomes of Noninvasive Ventilation in Acute Hypoxemic Respiratory Failure in a Respiratory intensive Care Unit in North India. Respiratory Care, 54(12), 679-687. Web.
Antonelli, M., Conti, G., Esquinas, A., Montini, L., Maggiore, S.M., Bello, G. et al. (2007). A multiple-center survey on the use in clinical practice of non-invasive ventilation as a first-line intervention for acute respiratory distress syndrome. Critical Care Medicine, 35(1), 18-25. Web.
Antonelli, M., Conti, G., Rocco, M., Bufi, M., Alberto De Blasi, R., Vivino, G. et al. (1998). A comparison of noninvasive ventilation positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure. The New England Journal of Medicine, 339(7) 429-35. Web.
Antro, C., Merico, F., Urbino, R., & Gai, V. (2005). Non invasive ventilation as a first line treatment for acute respiratory failure: real life experiences in the emergency department. Emergency Medicine Journal, 22(11), 772-77.
Gray, A.J., Goodacre, S., Newby, D.E., Masson, M.A., Sampson, F., Dixon, S. et al. (2009). A multicentre randomised controlled trial of the use of continuous positive airway pressure and non- invasive positive pressure ventilation in the early treatment of patients to the emergency department with severe cardiogenic pulmonary oedema: the 3CPO trial. Health Technology Assessment, 13(33), 1-108.
Gupta, P., Pendurthi, M.K., & Modrykamien, A.M. (2013). Extended Utilization of Noninvasive Ventilation for Acute Respiratory Failure and Its Clinical Outcomes. Respiratory Care, 58(5), 778-784.
Keenan, S.P., Sinuff, T., Burns, K.E.A., Muscedere, J., Kutsogiannis, J., Mehta, S. et al. (2011). Clinical practice guidelines for the use of noninvasive positive- pressure ventilation and oninvasive positive airway pressure in the acute care setting. Canada Medical Association Journal,183(3), 195-214.
Nava, S., Navalesi, P., & Conti, G. (2006). Time of non- invasive ventilation. Intensive Care Medicine, 32(3), 361-370.
Salman, A., Milbrandt, E.B., Pinsky, M.R. (2010). The role of noninvasive ventilation in acute cardiogenic pulmonary edema. Critical Care, 12(2), 1-3.
Walkey, A.J., Soylemez., & Wiener, S. (2012). Use of Noninvasive Ventilation in Patients with Acute Respiratory Failure, 2000-2009. American Thoracic Society, 10(1), 10-14.
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