Noninvasive positive pressure ventilation for acute respiratory failure: What role is there for patients declining intubation or choosing palliation?

摘要

Noninvasive positive pressure ventilation (NPPV) is a type of mechanical ventilation that does not require annartificial airway. The best results (decreased need for endotrcheal intubation and decreased mortality) havenbeen reported among patients with exacerbations of chronic obstructive pulmonary disease and cardiogenicnpulmonary edema. Although NPPV is a widely accepted treatment for some patients with acute respiratorynfailure, the use of NPPV in patients who have decided to forego endotracheal intubation is controversial.nNPPV as a palliative measure when patients and families have chosen to forego all life support, receivingncomfort measures only, may also be considered as a management option in very selected patients. In anynof these settings, NPPV should be applied only after careful discussion of the goals of care, with explicitnparameters for success and failure, by experienced personnel, and in appropriate healthcare settings. Innan era of patient-centered care, we have very little guidance in the literature from patients and familiesnregarding their perspectives on the use of technologies such as NPPV. Future studies need to examinenthe perspectives of patients and families on the use of NPPV within these contexts. In the interim, the onusnis on the clinician to engage the patient (where possible) and family members in a thorough discussion tonclarify their goals of care near the end-of-life prior to embarking on NPPV.