New Clinical Practice Guidelines, September 2017

Acute Respiratory Failure

Guidelines on acute respiratory failure by the European Respiratory Society/American Thoracic Society ^[2]

• Bilevel noninvasive mechanical ventilation (NIV) may be considered in chronic obstructive pulmonary disease (COPD) patients with an acute exacerbation in 3 clinical settings: (1) To prevent acute respiratory acidosis (ie, when the arterial CO₂ tension (PaCO₂) is normal or elevated but pH is normal); (2) To prevent endotracheal intubation and invasive mechanical ventilation in patients with mild-to-moderate acidosis and respiratory distress, with the aim of preventing deterioration to a point when invasive ventilation would be considered; (3) As an alternative to invasive ventilation in patients with severe acidosis and more severe respiratory distress.

• Bilevel NIV may also be used as the only method for providing ventilatory support in patients who are not candidates for or decline invasive mechanical ventilation.

• Bilevel NIV recommended for patients with acute respiratory failure (ARF) leading to acute or acute-on-chronic respiratory acidosis (pH ≤7.35) due to COPD exacerbation.

• Bilevel NIV recommended in patients considered to require endotracheal intubation and mechanical ventilation, unless the patient is immediately deteriorating.

• Either bilevel NIV or continuous positive airway pressure (CPAP) recommended for patients with ARF due to cardiogenic pulmonary edema.

• CPAP or bilevel NIV suggested for patients with ARF due to cardiogenic pulmonary edema in the prehospital setting

• Early NIV suggested for immunocompromised patients with ARF.

• NIV suggested for patients with postoperative ARF.

• Offer NIV to dyspneic patients for palliation in the setting of terminal cancer or other terminal conditions.

• NIV suggested to be used to prevent post-extubation respiratory failure in high-risk patients.

• NIV suggested NOT to be used to prevent post-extubation respiratory failure in non-high-risk patients.

• NIV suggested to be used to facilitate weaning from mechanical ventilation in patients with hypercapnic respiratory failure.

For further reading, see Respiratory Failure

Medscape © 2017  WebMD, LLC

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: John Anello, Brian Feinberg, John Heinegg, et. al. New Clinical Practice Guidelines, September 2017 - Medscape - Sep 15, 2017.