Noninvasive ventilation in medical intensive care medicine

Noninvasive ventilation refers to mechanical respiratory assist not requiring an endotracheal airway. Potential advantages include the reduction of complications resulting from intubation and invasive long-term mechanical ventilation and possibly a reduced time demand on medical personnel in the long run. Patients with additional severe organ failure, lacking ability to cooperate or high risk of aspiration are not suitable for noninvasive ventilation. Noninvasive ventilation has proven to be effective in reducing symptoms, need for intubation and mortality in selected patients with exacerbations of chronic obstructive lung disease. For pulmonary edema noninvasive CPAP (continuous positive airway pressure) reduces the symptoms and the need for intubation, although studies have not demonstrated a reduction in mortality. In other forms of acute respiratory failure noninvasive ventilation may be helpful, but its final role still has to be established. In these patients a trial of noninvasive ventilation appears to be safe as long as patients are carefully selected and intubation is not prolonged.