• A recent meta-analysis found that non-invasive ventilation can improve survival in acute care settings.
• Consider using NIPPV in:
  • COPD exacerbation
  • Obesity hypoventilation syndrome
  • Asthma
  • Hypoxemic respiratory failure
  • Cardiogenic pulmonary edema
  • ARDS
• Make sure to reassess your patients for improvement within one hour of applying NIPPV. If gas exchange has not significantly improved then endotracheal intubation and mechanical ventilation should be considered.
• Adverse effects:
  • Gastric distension
  • Pressure ulcers on the face
  • Can be uncomfortable
• In cardiogenic pulmonary edema there are cardiac performance benefits:
  • Decreases preload
  • Decreases left ventricular afterload
  • Improved cardiac ouput

References

Cabrini L et al. Noninvasive ventilation and survival in acute care settings: a comprehensive systematic review and metaanalysis of randomized controlled trials. Crit Care Med 2015; 43:880-888.