The early use of non-invasive ventilation averts mechanical ventilation and intubation in adult patients that present acute respiratory failures. NIV reduces mortality in such patients. Over the past two decades, NIV has exhibited a tremendous reduction in the mortality of patients that suffer from respiratory failures. The treatment improves gaseous exchange by delivering positive pressure of the airways through a fitted mask rather than a tracheostomy or endotracheal tube. Reduced mortality among patients that adopt NIV treatment is attributed to increased cardiac output and the reduced load of breathing in patients.
The ventilation modes that are used in NIV include CPAP (Continuous Positive Airway Pressure) and BiPAP (Bilateral Positive Airway Pressure). CPAP is responsible for maintenance of a positive airways pressure in the entire respiratory cycle. On the other hand, a further increase in airway pressure is noted during both inspiration and expiration when BiPAP is used (Gray et al, 2009; Keenan et al, 2011; Salman et al, 2010; Agarwal et al, 2009).
Moreover, in patients diagnosed with cardiogenic pulmonary oedema, CPAP provides better results (Antro et al, 2005; Walkey et al, 2012). The comfort of a patient is also improved using NIV following its preservation of airway defense mechanisms such as swallowing and speech (Nava et al, 2006; Kramer et al, 1995). Initiating NIV resolves breathlessness, respiratory distress and metabolic abnormalities. According to Antonneli et al (2007), improved FiO2 and PaO2 were noted in NIV-treated patients within one treatment hour (Antonelli et al, 1998; Antonelli et al, 2007).
The success of NIV treatment is dependent on whether contraindications result or not. As a result, positive outcomes are witnessed in the absence of contraindications. However, in the event of contraindications, the risk of intubation is increased (Gupta et al, 2013). NIV exhibits a failure rate of between 5%-50% depending on the severity of the respiratory infection. NIV is also preferred to mechanical ventilation following its 72% survival rate as compared to 53% rate noted under mechanical ventilation. NIV improvements should target increasing its rate of survival in patients suffering from chronic obstructive respiratory infections.
Humidification can be used to improve NIV’s outcomes in patients. This can be achieved through humidification and heating of air to the normal natural levels in the nasopharynx (31OC, 32 mg/L). This enhances the tolerance of a patient by increasing comfort, improving secretion clearance and minimizing airway drying.
References
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Antonelli, M., Conti, G., Rocco, M., Bufi, M., Alberto De Blasi, R., Vivino, G. et al. (1998). A comparison of noninvasive ventilation positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure. The New England Journal of Medicine, 339(7) 429-35. Web.
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