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Ventilation techniques: invasive versus noninvasive
1Fondazione Clinica del Lavoro IRCCS, Centro medico di Montescano, Pavia, Italy.
Summary
Noninvasive positive pressure ventilation (PPV) offers a promising alternative to invasive mechanical ventilation (MV) for COPD patients with acute respiratory failure (ARF), potentially reducing mortality and complications.
Area of Science:
- Pulmonology
- Critical Care Medicine
Background:
- Acute respiratory failure (ARF) in COPD patients has high mortality with conventional treatment.
- Invasive mechanical ventilation (MV) via endotracheal tube or tracheostomy is often required but carries significant complications and mortality (21-54%).
Purpose of the Study:
- To evaluate the efficacy and outcomes of noninvasive positive pressure ventilation (PPV) as an alternative to invasive MV in COPD patients with ARF.
Main Methods:
- Review of studies comparing noninvasive PPV (using facial or nasal masks) with invasive MV for ARF in COPD patients.
- Analysis of reported mortality rates, complications, and predictive factors for successful noninvasive PPV.
Main Results:
- Noninvasive PPV shows promising results with lower mortality rates (6-25%) compared to invasive MV.
- Advantages include intermittent ventilation, ability to swallow, speak, and cough, and easier weaning.
- Reported side-effects of noninvasive PPV are generally mild, including mask discomfort and skin irritation.
Conclusions:
- Noninvasive PPV is a viable and potentially life-saving alternative for managing ARF in COPD patients.
- Severity of acidosis and blood gas response predict successful noninvasive PPV.
- Preliminary data suggest reduced one-year mortality with noninvasive PPV compared to endotracheal ventilation.