[Pro: noninvasive positive pressure ventilation in respiratory insufficiency]

Patients who develop acute exacerbation of a chronic pulmonary disease (COPD), neuromuscular dysfunction and/or disorders of the ventilator control often require assistance of ventilation. transtracheal intubation presents risks of nosocomial pneumonia and injuries. There is general agreement that in patients with chronic alveolar hypoventilation noninvasive positive pressure ventilatory assistance improves ventilation, quality of life, and prolongs survival. Recently, some studies also demonstrate that noninvasive positive pressure ventilation may offer an alternative to intubation in some patients with COPD and lung edema. Noninvasive ventilatory assistance has benefits compared to ventilatory assistance via intubation if certain safeguards were used. These safeguards include extensive institutional experiences for noninvasive positive pressure ventilations, adequate physicians and respiratory care technicians to provide bedside skilled care and preparedness of emergent intubation, and the patient's mental alertness to tolerate noninvasive ventilatory techniques. The most pronounced benefits of noninvasive positive pressure ventilation was absence of side effects, shortening of time spent in ICU. The present clinical data support the hypothesis that noninvasive positive pressure ventilation may be an alternative for intubation in patient with acute respiratory failure and suggest further clinical investigative support.