eMedicine Specialties > Clinical Procedures > Respiratory Management

Noninvasive Ventilation

Author: Suneel Kumar Pooboni, MD, DCh, MRCP, FRCPCH, Consulting Staff, Pediatric Intensive Care and ECMO, University Hospitals of Leicester, UK
Coauthor(s): Devin R Boothe, MD, Staff Physician, Department of Emergency Medicine, Drexel University College of Medicine; Joshua E Markowitz, MD, Fellow and Clinical Instructor, Department of Emergency Medicine, Emergency Ultrasound, Drexel University College of Medicine
Contributor Information and Disclosures

Updated: Sep 16, 2009

Introduction

Noninvasive ventilation (NIV) can be defined as a ventilation modality that supports breathing without the need for intubation or surgical airway. Noninvasive ventilation is a popular method of adult respiratory management in both the emergency department and the intensive care unit (ICU), and it has gained increasing support in the care of pediatric patients. Besides avoiding the adverse effects of invasive ventilation, noninvasive ventilation has the added advantage of patient comfort. Noninvasive ventilation delivers mechanically assisted breaths without the placement of an artificial airway and has become an important mechanism of ventilator support both inside and outside the ICU.1,2

Noninvasive ventilation is further subdivided into negative pressure ventilation (NPV) and noninvasive positive pressure ventilation (NIPPV); the latter includes continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP). This article addresses all of these methods and briefly discusses heliox therapy.

Indications

Neonates and infants

  • Weaning from ventilator
  • Preventing collapse of the lung
  • Minimal need for respiratory support, with good respiratory drive
  • Bronchiolitis

Pediatric

Adults

  • Obstructive sleep apnea syndrome
  • Chronic obstructive pulmonary disease with exacerbation
  • Bilateral pneumonia
  • Acute congestive heart failure with pulmonary edema
  • Neuromuscular disorders
  • Acute lung injury
  • Weaning from ventilator (A 2009 meta-analysis indicated that noninvasive ventilation, as a method of weaning critically ill adults from invasive ventilation, was significantly associated with reduced mortality and ventilator-associated pneumonia. The net clinical benefits of this method have not yet been determined.4 )

Contraindications

Absolute contraindications 

  • Respiratory arrest or unstable cardiorespiratory status 
  • Uncooperative patients 
  • Inability to protect airway (impaired swallowing and cough)
  • Trauma or burns involving the face
  • Facial, esophageal, or gastric surgery
  • Apnea (poor respiratory drive)
  • Reduced consciousness
  • Air leak syndrome

Relative contraindications

  • Extreme anxiety
  • Morbid obesity
  • Copious secretions
  • Need for continuous or nearly continuous ventilatory assistance
  • Lack of respiratory drive
  • Diseases with air trapping, such as asthma (In a child on continuous positive airway pressure (CPAP) therapy, periodic monitoring is required. If the clinical condition and arterial blood gases deteriorate despite CPAP support, intubation should be considered.)

More on Noninvasive Ventilation

Overview: Noninvasive Ventilation
Treatment & Medication: Noninvasive Ventilation
Multimedia: Noninvasive Ventilation
References
Further Reading
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References

  1. Hostetler MA. Use of noninvasive positive-pressure ventilation in the emergency department. Emerg Med Clin North Am. Nov 2008;26(4):929-39, viii. [Medline].

  2. Plant PK, Owen JL, Elliott MW. Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial. Lancet. Jun 3 2000;355(9219):1931-5. [Medline].

  3. [Best Evidence] Moran F, Bradley JM, Piper AJ. Non-invasive ventilation for cystic fibrosis. Cochrane Database Syst Rev. Jan 21 2009;CD002769. [Medline].

  4. [Best Evidence] Burns KE, Adhikari NK, Keenan SP, Meade M. Use of non-invasive ventilation to wean critically ill adults off invasive ventilation: meta-analysis and systematic review. BMJ. May 21 2009;338:b1574. [Medline].

  5. Liesching T, Kwok H, Hill NS. Acute applications of noninvasive positive pressure ventilation. Chest. Aug 2003;124(2):699-713. [Medline].

  6. Ram FS, Picot J, Lightowler J, Wedzicha JA. Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev CD004104. 2004;(1).

  7. Rasanen J, Heikkila J, Downs J, Nikki P, Vaisanen I, Viitanen A. Continuous positive airway pressure by face mask in acute cardiogenic pulmonary edema. Am J Cardiol. Feb 1 1985;55(4):296-300. [Medline].

  8. Kleopa KA, Sherman M, Neal B, Romano GJ, Heiman-Patterson T. Bipap improves survival and rate of pulmonary function decline in patients with ALS. J Neurol Sci. Mar 15 1999;164(1):82-8. [Medline].

  9. Wood KA, Lewis L, Von Harz B, Kollef MH. The use of noninvasive positive pressure ventilation in the emergency department: results of a randomized clinical trial. Chest. May 1998;113(5):1339-46. [Medline].

  10. Sinuff T, Cook D, Randall J, Allen C. Noninvasive positive-pressure ventilation: a utilization review of use in a teaching hospital. CMAJ. Oct 17 2000;163(8):969-73. [Medline].

  11. Lopes CR, Brandao CM, Nozawa E, Auler JO Jr. Benefits of non-invasive ventilation after extubation in the postoperative period of heart surgery. Rev Bras Cir Cardiovasc. Sep 2008;23(3):344-50. [Medline].

  12. Hayek Z, Sohar E. External high frequency oscillation--concept and practice. Intensive Care World. Mar 1993;10(1):36-40. [Medline].

  13. Sharma S. Ventilation, Noninvasive. eMedicine from WebMD [serial online]. Updated May 15, 2006;Accessed September 30, 2008. Available at http://emedicine.medscape.com/article/304235-overview.

  14. Gainnier M, Arnal JM, Gerbeaux P, Donati S, Papazian L, Sainty JM. Helium-oxygen reduces work of breathing in mechanically ventilated patients with chronic obstructive pulmonary disease. Intensive Care Med. Oct 2003;29(10):1666-70. [Medline].

  15. Gupta VK, Cheifetz IM. Heliox administration in the pediatric intensive care unit: an evidence-based review. Pediatr Crit Care Med. Mar 2005;6(2):204-11. [Medline].

  16. Jaber S, Fodil R, Carlucci A, et al. Noninvasive ventilation with helium-oxygen in acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. Apr 2000;161(4 Pt 1):1191-200. [Medline].

  17. Corrado A, Gorini M. Negative-pressure ventilation: is there still a role?. Eur Respir J. Jul 2002;20(1):187-97. [Medline].

  18. Cvetnic WG, Waffarn F, Martin JM. Continuous negative pressure and intermittent mandatory ventilation in the management of pulmonary interstitial emphysema: a preliminary study. J Perinatol. Mar 1989;9(1):26-32. [Medline].

  19. Shekerdemian LS, Shore DF, Lincoln C, Bush A, Redington AN. Negative-pressure ventilation improves cardiac output after right heart surgery. Circulation. Nov 1 1996;94(9 Suppl):II49-55. [Medline].

  20. Sills JH, Cvetnic WG, Pietz J. Continuous negative pressure in the treatment of infants with pulmonary hypertension and respiratory failure. J Perinatol. Mar 1989;9(1):43-8. [Medline].

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Further Reading

AnaesthesiaUK: Noninvasive ventilation
 
Thomson A. The role of negative pressure ventilation. Arch Dis Child 1997;77:454-8.

Bach JR, ed. Non-invasive Mechanical Ventilation. Philadelphia, PA: Hanley & Belfus; 2002.

Millar D, Kirpalani H. Benefits of non invasive ventilation. Indian Pediatr. 2004 Oct;41(10):1008-17

Akash D, De Munter C, Desai A. Negative pressure ventilation in pediatric critical care setting. Indian J Pediatr. 2007 May;74(5):483-8.

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Keywords

noninvasive ventilation, apnea, sleep apnea, ventilation picture, apnea treatment, CPAP, ventilation, NIV, noninvasive positive pressure ventilation, NIPPV, NPPV, bilevel ventilation, bilevel positive airway pressure, BiPAP, continuous positive airway pressure, mask ventilation, negative pressure ventilation, Hayek, cuirass, heliox, airway, surgical airway, noninvasive airway, breathing support, breath support

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Contributor Information and Disclosures

Author

Suneel Kumar Pooboni, MD, DCh, MRCP, FRCPCH, Consulting Staff, Pediatric Intensive Care and ECMO, University Hospitals of Leicester, UK
Suneel Kumar Pooboni, MD, DCh, MRCP, FRCPCH is a member of the following medical societies: Indian Academy of Pediatrics, Royal College of Paediatrics and Child Health, Royal College of Physicians and Surgeons of Glasgow, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Devin R Boothe, MD, Staff Physician, Department of Emergency Medicine, Drexel University College of Medicine
Devin R Boothe, MD is a member of the following medical societies: American College of Emergency Physicians and American Medical Association
Disclosure: Nothing to disclose.

Joshua E Markowitz, MD, Fellow and Clinical Instructor, Department of Emergency Medicine, Emergency Ultrasound, Drexel University College of Medicine
Joshua E Markowitz, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Michael R Filbin, MD, Clinical Instructor, Department of Emergency Medicine, Massachusetts General Hospital
Michael R Filbin, MD is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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