TY - CHAP M1 - Book, Section TI - Noninvasive Ventilation A1 - Brochard, Laurent A1 - Akoumianaki, Evangelia A1 - Luiz Cordioli, Ricardo A2 - Hall, Jesse B. A2 - Schmidt, Gregory A. A2 - Kress, John P. PY - 2015 T2 - Principles of Critical Care, 4e AB - Many patients with ventilatory failure can be successfully managed with noninvasive positive pressure ventilation (NIPPV).NIPPV improves gas exchange, reduces the work of breathing, and relieves dyspnea.Patients most likely to benefit include those with acute hypercapnic exacerbations of chronic obstructive pulmonary disease (COPD) or hypercapnic forms of acute cardiogenic pulmonary edema.In selected patients with acute hypoxemic nonhypercapnic respiratory failure, NIPPV may obviate the need for endotracheal intubation. Selection may require exclusion of patients with hemodynamic instability, central neurologic dysfunction, or inability to protect the upper airway.In severely hypoxemic patients, undiscerning use of NIPPV may inappropriately delay intubation. In these patients, the decision to switch to endotracheal intubation should be made in the first hours.The use of NIPPV to treat postextubation respiratory distress has not been found to be superior to conventional management. Preventive use of NIV in selected group of patients may, however, be useful.The first hour on NIPPV is important in predicting the outcome and requires experience from clinicians and to spend time at the bedside with the patient.A favorable response to NIPPV is usually apparent within the first 2 hours. Absence of improvements in dyspnea, respiratory rate, and gas exchange in this period strongly suggests a need for endotracheal intubation.Typical settings in a patient with COPD include pressure support of 10 to 15 cm H2O above a positive end-expiratory pressure (PEEP) of 5 cm H2O.In appropriately selected patients, NIPPV allows a shorter hospital stay and produces better outcomes than does endotracheal mechanical ventilation. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accessmedicine.mhmedical.com/content.aspx?aid=1107718026 ER -