Respiratory Failure Guidelines

Updated: Apr 07, 2020
  • Author: Ata Murat Kaynar, MD; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Guidelines Summary

Summary of guidelines on acute respiratory failure (ARF) by the European Respiratory Society/American Thoracic Society

Bilevel noninvasive mechanical ventilation (NIV) may be considered in chronic obstructive pulmonary disease (COPD) patients with an acute exacerbation in the following three clinical settings [18] :

  • To prevent acute respiratory acidosis (ie, when the arterial carbon dioxide tension [PaCO 2] is normal or elevated but pH is normal)
  • To prevent endotracheal intubation and invasive mechanical ventilation in patients with mild-to-moderate acidosis and respiratory distress, with the aim of preventing deterioration to a point when invasive ventilation would be considered
  • As an alternative to invasive ventilation in patients with severe acidosis and more severe respiratory distress

Bilevel NIV also may be used as the only method for providing ventilatory support in patients who are not candidates for or decline invasive mechanical ventilation. [18]

Bilevel NIV is recommended as follows [18] :

  • Patients with ARF leading to acute or acute-on-chronic respiratory acidosis (pH ≤7.35) due to COPD exacerbation
  • Patients considered to require endotracheal intubation and mechanical ventilation, unless the patient is immediately deteriorating

Either bilevel NIV or continuous positive airway pressure (CPAP) is recommended for patients with ARF due to cardiogenic pulmonary edema. [18]

CPAP or bilevel NIV is suggested for patients with ARF due to cardiogenic pulmonary edema in the prehospital setting. [18]

Early NIV is suggested for immunocompromised patients with ARF. [18]

NIV use is suggested as follows [18] :

  • For patients with postoperative ARF
  • Can be offered to dyspneic patients for palliation in the setting of terminal cancer or other terminal conditions
  • For the prevention of postextubation respiratory failure in high-risk patients; not suggested to prevent postextubation respiratory failure in non–high-risk patients
  • To facilitate weaning from mechanical ventilation in patients with hypercapnic respiratory failure