HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (38) Citing Articles via Google Scholar Google Scholar Articles by Liesching, T. Articles by Hill, N. S. Search for Related Content PubMed PubMed Citation Articles by Liesching, T. Articles by Hill, N. S.

Acute Applications of Noninvasive Positive Pressure Ventilation^*

^* From the Division of Pulmonary, Critical Care and Sleep Medicine (Drs. Liesching and Hill), Brown Medical School, Providence, RI; and the Department of Respiratory Medicine (Dr. Kwok), Ruttonjee Hospital, Hong Kong.

Correspondence to: Nicholas S. Hill, MD, FCCP, Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts-New England Medical Center, 750 Washington St, No. 257, Boston, MA 02111; e-mail: nhill{at}tufts-nemc.org

Noninvasive positive-pressure ventilation (NPPV) has been used increasingly to treat acute respiratory failure (ARF). The best indications for its use are ARF in patients with COPD exacerbations, acute pulmonary edema, and immunocompromised states. For these indications, multiple controlled trials have demonstrated that therapy with NPPV avoids intubation and, in the case of COPD and immunocompromised patients, reduces mortality as well. NPPV is used to treat patients with numerous other forms of ARF, but the evidence is not as strong for its use in those cases, and patients must be selected carefully. The best candidates for NPPV are able to protect their airway, are cooperative, and are otherwise medically stable. Success is optimized when a skilled team applies a well-fitted, comfortable interface. Ventilator settings should be adjusted to reduce respiratory distress while avoiding excessive discomfort, patient-ventilator synchrony should be optimized, and adequate oxygenation should be assured. The appropriate application of NPPV in the acute care setting should lead to improved patient outcomes and more efficient resource utilization.

Key Words: acute respiratory failure • COPD • mechanical ventilation • noninvasive ventilation • pulmonary edema

This article has been cited by other articles:

				E. Garpestad, J. Brennan, and N. S. Hill Noninvasive Ventilation for Critical Care Chest, August 1, 2007; 132(2): 711 - 720. [Abstract] [Full Text] [PDF]

				S. M. Koenig and J. D. Truwit Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention Clin. Microbiol. Rev., October 1, 2006; 19(4): 637 - 657. [Abstract] [Full Text] [PDF]

				D. S. Hui, S. D. Hall, M. T.V. Chan, B. K. Chow, J. Y. Tsou, G. M. Joynt, C. E. Sullivan, and J. J.Y. Sung Noninvasive positive-pressure ventilation: an experimental model to assess air and particle dispersion. Chest, September 1, 2006; 130(3): 730 - 740. [Abstract] [Full Text] [PDF]

				E. Garpestad and N. Hill Noninvasive Ventilation for Acute Respiratory Failure: But How Severe? Chest, December 1, 2005; 128(6): 3790 - 3791. [Full Text] [PDF]

				S Muzaffar, N Shukla, G D Angelini, and J Y Jeremy Acute hypoxia simultaneously induces the expression of gp91phox and endothelial nitric oxide synthase in the porcine pulmonary artery Thorax, April 1, 2005; 60(4): 305 - 313. [Abstract] [Full Text] [PDF]

				J. D. Truwit and G. R. Bernard Noninvasive Ventilation -- Don't Push Too Hard N. Engl. J. Med., June 10, 2004; 350(24): 2512 - 2515. [Full Text] [PDF]