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Noninvasive Ventilatory Support in Acute Respiratory Distress Syndrome

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Acute Respiratory Distress Syndrome

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Abstract

The current ventilation strategy of acute respiratory distress syndrome (ARDS) is based on the use of lung-protective invasive ventilation. Since invasive ventilation is associated with potentially severe complications, there is a growing interest for alternative ventilatory support such as noninvasive ventilation (NIV) and heat and humidified high-flow oxygenation through nasal cannula (1). While NIV exerts evidenced beneficial effects in patients presenting with severe exacerbation of chronic obstructive pulmonary disease or cardiogenic pulmonary edema, the use of NIV in acute hypoxemic respiratory failure related to early ARDS is still debated. Moreover, NIV can also be deleterious in some patients, mostly by delaying needed intubation (2). There is a high interest for high-flow oxygenation through nasal cannula. High-flow oxygenation through nasal cannula has been investigated in adults with acute hypoxemic respiratory failure with interesting findings. The exact positioning of this technique needs more assessment as well as determining its mechanisms of action (3). Immunocompromised patients are a subset of patients in whom the effect of NIV has been shown to be beneficial. However, the improved prognosis of these patients over the recent years, even under mechanical ventilation, necessitates a reappraisal of its effects (4). Lastly, an important emerging concern comes from the fact that some non-intubated patients with a high respiratory drive may develop an injurious breathing pattern and self-inflict lung injury. The optimal treatment may then be sedation, intubation, and application of a lung-protective ventilation.

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Authors and Affiliations

  1. Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS_1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France

    Martin DRES MD

  2. Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada

    Martin DRES MD & Laurent Brochard MD

  3. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada

    Martin DRES MD & Laurent Brochard MD

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  1. Martin DRES MD
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  2. Laurent Brochard MD
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Correspondence to Laurent Brochard MD .

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  1. Department of "Scienze della Salute", University of Milan, Director of Anaesthesia and Intensive Care Services , ASST Santi Paolo e Carlo, Milan, Italy

    Davide Chiumello

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DRES, M., Brochard, L. (2017). Noninvasive Ventilatory Support in Acute Respiratory Distress Syndrome. In: Chiumello, D. (eds) Acute Respiratory Distress Syndrome. Springer, Cham. https://doi.org/10.1007/978-3-319-41852-0_15

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  • DOI: https://doi.org/10.1007/978-3-319-41852-0_15

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