Noninvasive Ventilation Procedures

Noninvasive Ventilation Procedures

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Noninvasive ventilation (NIV) can be defined as a ventilation modality that supports breathing by delivering mechanically assisted breaths without the need for intubation or surgical airway. It is a popular method of adult respiratory management in both the emergency department (ED) and the intensive care unit (ICU), and it is increasingly used in the care of pediatric patients. Besides avoiding the adverse effects of invasive ventilation, NIV has the added advantage of patient comfort. It has become an important mechanism of ventilator support both inside and outside the ICU. [1, 2, 3]

NIV is subdivided into negative-pressure ventilation (NPV) and noninvasive positive-pressure ventilation (NIPPV); the latter is further subdivided into continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP). This article addresses all of these methods and briefly discusses heliox adjunct therapy.

NIV is indicated in neonates and infants as follows:

NIV is indicated in children as follows:

NIV is indicated in adults as follows:

Absolute contraindications for NIV are as follows:

Relative contraindications for NIV are as follows:

A large retrospective cohort study by Lindenauer et al found that patients with severe COPD exacerbations who were treated with NIV at the time of hospitalization had lower inpatient mortality, shorter length of stay, and lower costs than patients who were treated with invasive mechanical ventilation. [6]

Another large retrospective cohort study found that in 1254 patients hospitalized with asthma exacerbation and receiving ventilatory support in the form of NIV or invasive mechanical ventilation, those successfully treated with NIV appeared to have better outcomes than those treated with invasive mechanic ventilation. [7]  However, it is possible that NIV may have been used selectively in a lower risk group. 

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Plant PK, Owen JL, Elliott MW. Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial. Lancet. 2000 Jun 3. 355 (9219):1931-5. [Medline].

Moerer O, Harnisch LO, Herrmann P, Zippel C, Quintel M. Patient-Ventilator Interaction During Noninvasive Ventilation in Simulated COPD. Respir Care. 2016 Jan. 61 (1):15-22. [Medline].

Moran F, Bradley JM, Piper AJ. Non-invasive ventilation for cystic fibrosis. Cochrane Database Syst Rev. 2009 Jan 21. CD002769. [Medline].

Burns KE, Adhikari NK, Keenan SP, Meade M. Use of non-invasive ventilation to wean critically ill adults off invasive ventilation: meta-analysis and systematic review. BMJ. 2009 May 21. 338:b1574. [Medline]. [Full Text].

Lindenauer PK, Stefan MS, Shieh MS, Pekow PS, Rothberg MB, Hill NS. Outcomes associated with invasive and noninvasive ventilation among patients hospitalized with exacerbations of chronic obstructive pulmonary disease. JAMA Intern Med. 2014 Dec. 174 (12):1982-93. [Medline]. [Full Text].

Stefan MS, Nathanson BH, Lagu T, Priya A, Pekow PS, Steingrub JS, et al. Outcomes of Noninvasive and Invasive Ventilation in Patients Hospitalized with Asthma Exacerbation. Ann Am Thorac Soc. 2016 Jul. 13 (7):1096-104. [Medline]. [Full Text].

Olivieri C, Longhini F, Cena T, Cammarota G, Vaschetto R, Messina A, et al. New versus Conventional Helmet for Delivering Noninvasive Ventilation: A Physiologic, Crossover Randomized Study in Critically Ill Patients. Anesthesiology. 2016 Jan. 124 (1):101-8. [Medline].

Liesching T, Kwok H, Hill NS. Acute applications of noninvasive positive pressure ventilation. Chest. 2003 Aug. 124 (2):699-713. [Medline].

Räsänen J, Heikkilä J, Downs J, Nikki P, Väisänen I, Viitanen A. Continuous positive airway pressure by face mask in acute cardiogenic pulmonary edema. Am J Cardiol. 1985 Feb 1. 55 (4):296-300. [Medline].

Kleopa KA, Sherman M, Neal B, Romano GJ, Heiman-Patterson T. Bipap improves survival and rate of pulmonary function decline in patients with ALS. J Neurol Sci. 1999 Mar 15. 164 (1):82-8. [Medline].

Liao G, Chen R, He J. Prophylactic use of noninvasive positive pressure ventilation in post-thoracic surgery patients: A prospective randomized control study. J Thorac Dis. 2010 Dec. 2 (4):205-9. [Medline]. [Full Text].

Dhand R. Aerosol therapy in patients receiving noninvasive positive pressure ventilation. J Aerosol Med Pulm Drug Deliv. 2012 Apr. 25 (2):63-78. [Medline].

Osadnik CR, Tee VS, Carson-Chahhoud KV, Picot J, Wedzicha JA, Smith BJ. Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2017 Jul 13. 7:CD004104. [Medline].

Lim WJ, Mohammed Akram R, Carson KV, Mysore S, Labiszewski NA, Wedzicha JA, et al. Non-invasive positive pressure ventilation for treatment of respiratory failure due to severe acute exacerbations of asthma. Cochrane Database Syst Rev. 2012 Dec 12. 12:CD004360. [Medline].

Suh MR, Choi WA, Kim DH, Lee JW, Kim EY, Kang SW. Five-Year Follow-Up and Outcomes of Noninvasive Ventilation in Subjects With Neuromuscular Diseases. Respir Care. 2018 Mar. 63 (3):274-281. [Medline].

Wood KA, Lewis L, Von Harz B, Kollef MH. The use of noninvasive positive pressure ventilation in the emergency department: results of a randomized clinical trial. Chest. 1998 May. 113 (5):1339-46. [Medline].

Demoule A, Chevret S, Carlucci A, et al, oVNI Study Group., REVA Network (Research Network in Mechanical Ventilation). Changing use of noninvasive ventilation in critically ill patients: trends over 15 years in francophone countries. Intensive Care Med. 2016 Jan. 42 (1):82-92. [Medline].

Sinuff T, Cook D, Randall J, Allen C. Noninvasive positive-pressure ventilation: a utilization review of use in a teaching hospital. CMAJ. 2000 Oct 17. 163 (8):969-73. [Medline].

Lopes CR, Brandão CM, Nozawa E, Auler JO Jr. Benefits of non-invasive ventilation after extubation in the postoperative period of heart surgery. Rev Bras Cir Cardiovasc. 2008 Jul-Sep. 23 (3):344-50. [Medline].

Hayek Z, Sohar E. External high frequency oscillation–concept and practice. Intensive Care World. 1993 Mar. 10 (1):36-40. [Medline].

Gupta VK, Cheifetz IM. Heliox administration in the pediatric intensive care unit: an evidence-based review. Pediatr Crit Care Med. 2005 Mar. 6 (2):204-11. [Medline].

Jaber S, Fodil R, Carlucci A, Boussarsar M, Pigeot J, Lemaire F, et al. Noninvasive ventilation with helium-oxygen in acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2000 Apr. 161 (4 Pt 1):1191-200. [Medline].

Gainnier M, Arnal JM, Gerbeaux P, Donati S, Papazian L, Sainty JM. Helium-oxygen reduces work of breathing in mechanically ventilated patients with chronic obstructive pulmonary disease. Intensive Care Med. 2003 Oct. 29 (10):1666-70. [Medline].

Soo Hoo GW. Noninvasive ventilation. Medscape Drugs & Diseases. Available at http://emedicine.medscape.com/article/304235-overview. December 15, 2017; Accessed: March 16, 2018.

Suneel Kumar Pooboni, MD, , FRCPCH, FRCP(Edin), FCCP Consulting Staff, Pediatric Intensive Care and ECMO, University Hospitals of Leicester, UK

Suneel Kumar Pooboni, MD, , FRCPCH, FRCP(Edin), FCCP is a member of the following medical societies: Society of Critical Care Medicine, Royal College of Physicians and Surgeons of Glasgow, Royal College of Paediatrics and Child Health, Indian Academy of Pediatrics

Disclosure: Nothing to disclose.

Joshua E Markowitz, MD, RDMS, FACEP Attending Physician, Department of Emergency Medicine, Emergency Medical Services Liaison, Assistant Lead for Disaster Preparedness, Kaiser Santa Clara Medical Center; Clinical Assistant Professor (Affiliate) of Emergency Medicine, Stanford University School of Medicine

Joshua E Markowitz, MD, RDMS, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Emergency Medicine Residents’ Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Zab Mosenifar, MD, FACP, FCCP Geri and Richard Brawerman Chair in Pulmonary and Critical Care Medicine, Professor and Executive Vice Chairman, Department of Medicine, Medical Director, Women’s Guild Lung Institute, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD, FACP, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic Society

Disclosure: Nothing to disclose.

Michael R Filbin, MD, FACEP Clinical Instructor, Department of Emergency Medicine, Massachusetts General Hospital

Michael R Filbin, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Devin R Boothe, MD Staff Physician, Department of Emergency Medicine, Drexel University College of Medicine

Devin R Boothe, MD is a member of the following medical societies: American College of Emergency Physicians and American Medical Association

Disclosure: Nothing to disclose.

Noninvasive Ventilation Procedures

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