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
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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.