Non-invasive ventilation

Non-invasive ventilation
The setup for non-invasive ventilation using a mechanical ventilator. Modern devices are often much smaller.
Synonyms Non-invasive positive pressure ventilation (NIPPV), NIV, NPPV

Non-invasive ventilation (NIV) is the use of airway support administered through a face (nasal) mask instead of an endotracheal tube. Inhaled gases are given with positive end-expiratory pressure often with pressure support or with assist control ventilation at a set tidal volume and rate. Numerous studies have shown this technique to be as effective as, and better tolerated than, intubation and mechanical ventilation in patients with exacerbations of COPD.[1] It is termed "non-invasive" because it is delivered with a mask that is tightly fitted to the face, but without a need for tracheal intubation. While there are similarities with regards to the interface, NIV is not the same as continuous positive airway pressure (CPAP), which applies a single level of positive airway pressure throughout the whole respiratory cycle;[2] CPAP does not deliver ventilation but is occasionally used in conditions also treated with NIV.[3]

Medical uses

NIV can be used acutely and long-term. In some people who have presented with acute respiratory failure, there is an ongoing need for long-term use of NIV at home.[3]

Acute

NIV for acute respiratory failure is used particularly for severe exacerbations of chronic obstructive pulmonary disease (COPD) but also for acute decompensated heart failure and other acute conditions.[4] In acute cardiogenic pulmonary oedema caused by decompensated heart failure, the quality of evidence is poor but studies have shown a reduced risk of death and a decreased need for tracheal intubation for both NIV and CPAP.[5]

Chronic/home

Chronic use of NIV ("home NIV") may be indicated for severe COPD.[6]

Home NIV may also be indicated in people with neuromuscular disease and chest wall deformity.[3] People with obesity hypoventilation syndrome often require NIV initially in their care, but many can be switched to CPAP.[3]

People with motor neuron disease (MND) may require home NIV in the course of their illness. Guidelines in the United Kingdom stipulate that assessment of respiratory function is part of the multidisciplinary management of MND.[7]

Terminology

A number of terms have been used in the medical literature to describe NIV. The more formal name non-invasive positive pressure ventilation (NPPV or NIPPV) has been used to distinguish it from the use of the now very rare negative pressure ventilator ("iron lung"). The brand name BiPAP/BIPAP has also enjoyed a degree of popularity, after an early NIV machine produced by Respironics, but its use is now discouraged.[8]

History

Non-invasive ventilation has been used since the 1940s for various indications, but its present-day use for chronic breathing problems arose in the 1980s for people with chronic respiratory muscle weakness, and in the 1990s on intensive care units and other acute care settings for acute respiratory failure.[8]

Since 2000 acute NIV has been used widely in the treatment of acute respiratory failure, particularly in people with COPD, including on general wards rather than the intensive care unit setting. In the United Kingdom, a 2017 report by NCEPOD found that there were widespread problems in the delivery of high-quality care to patients.[9]

References

  1. ↑ <NIV Definition>
  2. ↑ C. Hormann; M. Baum; C. Putensen; N. J. Mutz; H. Benzer (January 1994). "Biphasic positive airway pressure (BIPAP)--a new mode of ventilatory support". European Journal of Anaesthesiology. 11 (1): 37–42. PMID 8143712.
  3. 1 2 3 4 Davidson, A Craig; Banham, Stephen; Elliott, Mark; Kennedy, Daniel; Gelder, Colin; Glossop, Alastair; Church, Alistair Colin; Creagh-Brown, Ben; Dodd, James William; Felton, Tim; Foëx, Bernard; Mansfield, Leigh; McDonnell, Lynn; Parker, Robert; Patterson, Caroline Marie; Sovani, Milind; Thomas, Lynn (14 March 2016). "BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults". Thorax. 71 (Suppl 2): ii1–ii35. doi:10.1136/thoraxjnl-2015-208209. PMID 26976648.
  4. ↑ Nava, Stefano; Hill, Nicholas (July 2009). "Non-invasive ventilation in acute respiratory failure". The Lancet. 374 (9685): 250–259. doi:10.1016/S0140-6736(09)60496-7. PMID 19616722.
  5. ↑ Vital, FM; Ladeira, MT; Atallah, AN (31 May 2013). "Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema". The Cochrane Database of Systematic Reviews (5): CD005351. doi:10.1002/14651858.CD005351.pub3. PMID 23728654.
  6. ↑ Arnal, Jean-Michel; Texereau, Joëlle; Garnero, Aude (24 March 2017). "Practical Insight to Monitor Home NIV in COPD Patients". COPD: Journal of Chronic Obstructive Pulmonary Disease: 1–10. doi:10.1080/15412555.2017.1298583. PMID 28339316.
  7. ↑ Guideline Development Group (February 2016). "Motor neurone disease: assessment and management". National Institute for Health and Clinical Excellence. NICE. Retrieved 19 July 2017.
  8. 1 2 Pierson, DJ (January 2009). "History and epidemiology of noninvasive ventilation in the acute-care setting". Respiratory care. 54 (1): 40–52. PMID 19111105.
  9. ↑ Juniper, M; Ellis, G; Smith, NCE; Protopata, KL; Mason, M (July 2017). "Non-Invasive Ventilation: Inspiring Change (2017)". NCEPOD. Retrieved 19 July 2017.
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