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Noninvasive Ventilation for Acute Respiratory Failure

Laurent Brochard, MD
JAMA. 2002;288(8):932-935. doi:10.1001/jama.288.8.932.
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Noninvasive ventilation (NIV) delivers mechanical ventilatory support to the lungs with a noninvasive interface between the patient and the ventilator. Noninvasive ventilation has been reported to reduce the incidence of complications of mechanical ventilation and to improve outcomes.18

In contrast with endotracheal mechanical ventilation (ETMV), the interface is usually a nasal mask or a facemask, which must be used properly to avoid air leaks, nose abrasion, eye irritation, and poor overall clinical tolerance. In patients with acute respiratory failure who breathe through the mouth, the nasal mask carries a greater risk of leakage, which can markedly diminish the effectiveness of the technique and worsen the clinical status of the patient.9,10 Thus, in the setting of the intensive care unit (ICU), the full facemask covering both the nose and the mouth is gaining preference, at least during the early phase of NIV.11 Leaks can induce patient-ventilator asynchrony, generate nasal congestion and an increase in nasal resistance,12 and make the technique inefficient. In stable patients with chronic respiratory failure, full facemasks also have been found to be more effective than nasal masks in increasing tidal volume and reducing PCO2, although nasal masks were more comfortable.13 Nasal masks are usually used for home ventilation.

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