Noninvasive Ventilation

  • Eric Bui


Noninvasive ventilation (NIV) has been used for many years with great benefit in treating conditions such as chronic obstructive pulmonary disease (COPD) and cardiogenic pulmonary edema. These results have led to clinicians exploring the use of NIV outside of only chronic conditions and applying it to the acute and critical care setting. This alternative to traditional invasive ventilation in patients with respiratory compromise has garnered much interest in recent years. NIV potentially can provide the same therapeutic benefits of invasive ventilation while avoiding complications such as ventilator-associated pneumonia, prolonged intensive care unit (ICU) stays, and death. Data has begun to emerge showing the efficacy of NIV in patients with post-extubation respiratory failure, postoperative respiratory failure, and hypoxemic respiratory failure ranging from causes such as trauma to mild adult respiratory distress syndrome (ARDS). The currently available literature appears to show that NIV can be used to successfully treat these conditions while possibly improving outcomes when compared to traditional therapies. Despite these promising results, there is still a lack of high-quality evidence to support the routine use of NIV for every critical care application. As such, NIV should be viewed as a tool to be used in carefully selected patients who meet specific criteria but should not be seen as a replacement for invasive mechanical ventilation when it is clinically indicated. With this in mind, NIV can be an effective strategy when used in appropriate situations and should be considered a viable option for treating respiratory failure from a variety of causes.


Noninvasive ventilation Respiratory failure Hypoxia Hypercapnia ARDS 


  1. 1.
    Hill NS. Clinical applications of body ventilators. Chest. 1986;90(6):897–905.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    McNeill GBS, Glossop AJ. Clinical applications of non-invasive ventilation in critical care. Contin Educ Anaesth Crit Care Pain. 2011;12(12):33–7.Google Scholar
  3. 3.
    Bott J, Carroll MP, Conway JH, et al. Randomised controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive pulmonary disease. Lancet. 1993;341:1555–7.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Brochard L, Mancebo J, Wysocki M, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med. 1995;333:817–22.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Collaborative Research Group of Noninvasive Mechanical Ventilation for Chronic Obstructive Pulmonary Disease. Early use of non-invasive positive pressure ventilation for acute exacerbations of chronic obstructive pulmonary disease: a multicenter randomized controlled trial. Chin Med J. 2005;118:2034–40.Google Scholar
  6. 6.
    Ram FSF, Picot J, Lightowler J, et al. Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2004;3:CD004104.Google Scholar
  7. 7.
    Quon BS, Gan WQ, Sin DD. Contemporary management of acute exacerbations of COPD: a systematic review and metaanalysis. Chest. 2008;133:756–66.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Cabrini L, Landoni G, Oriani A, et al. Noninvasive ventilation and survival in acute care settings: a comprehensive systematic review and Metaanalysis of randomized controlled trials. Crit Care Med. 2015;43(4):880–8.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Masip J, Betbese AJ, Paez J, et al. Non-invasive pressure support ventilation versus conventional oxygen therapy in acute cardiogenic pulmonary oedema: a randomized trial. Lancet. 2000;356:2126–32.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Levitt MA. A prospective, randomized trial of BiPAP in severe acute congestive heart failure. J Emerg Med. 2001;21:363–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Kelly CA, Newby DE, McDonagh TA, et al. Randomised controlled trial of continuous positive airway pressure and standard oxygen therapy in acute pulmonary oedema. Eur Heart J. 2002;23:1379–86.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Nava S, Carbone G, DiBattista N, et al. Noninvasive ventilation in cardiogenic pulmonary edema: a multicenter, randomized trial. Am J Resipr. Crit Care Med. 2003;168:1432–7.CrossRefGoogle Scholar
  13. 13.
    Park M, Sangean MC, Volpe M, et al. Randomized, prospective trial of oxygen, continuous positive airway pressure, and bilevel positive airway pressure by face mask in acute cardiogenic pulmonary edema. Crit Care Med. 2004;32:2407–15.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    British Thoracic Society Standards of Care Committee. Non-invasive ventilation in acute respiratory failure. Thorax. 2002;57:192–211.CrossRefGoogle Scholar
  15. 15.
    Keenan SP, Sinuff T, Burns KE, et al. Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting. CMAJ. 2011;183:E195–214.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Mehta S, Jay GD, Woolard RH, et al. Randomized, prospective trial of bilevel versus continuous positive airway pressure in acute pulmonary edema. Crit Care Med. 1997;25:620–8.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Burns KEA, Meade MO, Premji A, et al. Noninvasive positive-pressure ventilation as a weaning strategy for intubated adults with respiratory failure. Cochrane Database Syst Rev. 2013;12:CD004127.Google Scholar
  18. 18.
    Lin C, Yu H, Fan H, et al. The efficacy of noninvasive ventilation in managing postextubation respiratory failure: a meta-analysis. Heart Lung. 2014;43(2):99–104.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Arozullah AM, Daley J, Henderson WG, et al. Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. The National Veterans Administration Surgical Quality Improvement Program. Ann Surg. 2000;232:242–53.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Jaber S, Lescot T, Futier E. Effect of noninvasive ventilation on tracheal reintubation among patients with hypoxemic respiratory failure following abdominal surgery. JAMA. 2016;315(13):1345–53.CrossRefPubMedGoogle Scholar
  21. 21.
    Chiumello D, Chevallard G, Gregoretti C. Non-invasive ventilation in postoperative patients: a systematic review. Intensive Care Med. 2011;37:918–29.CrossRefPubMedGoogle Scholar
  22. 22.
    Antonelli M, Conti G, Rocco M, et al. A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure. N Engl J Med. 1998;339:429–35.CrossRefPubMedGoogle Scholar
  23. 23.
    Ferrer M, Esquinas A, Leon M, et al. Noninvasive ventilation in severe hypoxemic respiratory failure: a randomized clinical trial. Am J Respir Crit Care Med. 2003;168(12):1438–44.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Thille A, Contou D, Fragnoli C, et al. Non-invasive ventilation for acute hypoxemic respiratory failure: intubation rate and risk factors. Crit Care. 2013;17:R269.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryUCSF East Bay – Highland HospitalOaklandUSA

Personalised recommendations