Mechanical ventilation is required for patients with acute or acute-on-chronic respiratory failure that does not respond to standard therapeutic interventions such as administration of antibiotics, diuretics, bronchodilators and – not to be forgotten – oxygen. The majority of patients requiring ventilatory support are intubated and ventilated invasively. Actually we do regard this as conventional mechanical ventilation. Although initiating invasive mechanical ventilation can be a life-saving intervention, it is just supportive rather than curative and gives us the chance to treat underlying disease. In contrast, conventional mechanical ventilation is associated with several complications, related to the intubation as well as to the risk of developing a ventilator-associated pneumonia (VAP). In order to avoid these risks, an alternative to conventional mechanical ventilation was invented in the nineteen-eighties known as Non Invasive Ventilation (NIV). With NIV, a nasal or face mask is used to deliver ventilatory support to the patient instead of an endotracheal tube. Since its introduction, NIV has been applied in different ventilator modes to many different patient categories with acute, acute-on-chronic and even chronic respiratory failure, both within and outside the Intensive Care environment.
To determine the value of a certain therapy, one has to consider its advantages and disadvantages and, if possible compare it with conventional treatment. In the text below I would like to focus on the disadvantages of Non Invasive Mechanical Ventilation for acute or acute-on-chronic respiratory failure within the Intensive Care Unit.
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