Noninvasive Ventilatory Support in Acute Respiratory Distress Syndrome
The current ventilation strategy of acute respiratory distress syndrome (ARDS) is based on the use of lung-protective invasive ventilation. Since invasive ventilation is associated with potentially severe complications, there is a growing interest for alt
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Martin DRES and Laurent Brochard
15.1 Introduction Invasive mechanical ventilation is the cornerstone of the treatment of acute respiratory failure. Nevertheless, it is now well established that invasive mechanical ventilation can expose patients to several potential complications such as ventilator-induced diaphragm dysfunction [1], ventilator-acquired pneumonia [2], and/or ventilator- induced lung injury (VILI) [3]. These complications, some of them potentially lethal, encouraged clinicians to consider alternatives to invasive mechanical ventilation in patients presenting acute respiratory failure. Noninvasive ventilation (NIV) has become an inescapable strategy in acute hypercapnic respiratory failure related to exacerbation of chronic obstructive pulmonary disease (COPD) and/or cardiogenic pulmonary edema. In these two settings, NIV has been shown to reduce the risk of intubation and mortality [4, 5]. Since more than two decades, the scope of NIV application has largely been expended beyond acute hypercapnic respiratory failure. Currently, NIV is applied in various settings such as immunocompromised patients with acute hypoxemic respiratory failure [6], periprocedural management M. DRES, MD Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS_1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada L. Brochard, MD (*) Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada e-mail: [email protected] © Springer International Publishing Switzerland 2017 D. Chiumello (ed.), Acute Respiratory Distress Syndrome (ARDS), DOI 10.1007/978-3-319-41852-0_15
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such as bronchoscopy and bronchoalveolar lavage in hypoxemic patients [7], post- extubation in high-risk patients [8], or in postoperative patients [9] with beneficial results after abdominal surgery [10, 11]. In acute hypoxemic respiratory failure, the benefit of NIV on the reduction of intubation rate and mortality has been suggested in a meta-analysis from five randomized controlled trials [12]. Acute respiratory distress syndrome (ARDS) represents the most severe form of hypoxemic acute respiratory failure [13], and the heterogeneity of circumstances causing this condition makes difficult to perfectly interpret the benefits of NIV in this group of patients. In the present chapter, we will discuss the rationale, benefits, and risks of the use of NIV in acute hypoxemic respiratory failure. We will not strictly focus on ARDS since the criteria for its diagnosis are not always present before intubation, e.g., the need for a positive end-expiratory pressure of 5 cmH2O or higher, and there a
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