Over the past few years, noninvasive ventilation
(NIV) with only PEEP (CPAP) or pressure
support with PEEP has been increasingly applied
during various episodes of acute respiratory
failure. This led to a relevant number of
published clinical studies dealing with the
application of this technique in the different
varieties of an acute respiratory insufficiency,
particularly in patients with an acute exacerbation
of COPD and in those presenting
with an acute cardiogenic pulmonary oedema.
Strongly supported through pathophysiological,
clinical and epidemiological data, NIV is
currently considered an evidence-based applied
treatment in both conditions.
Considering the encouraging consequences
on the decline of hospital-acquired
infections (ventilator-associated pneumonia)
through the reduction of intubation rate and
the potential positive effects on lung tissue
recruitment, NIV has become an attractive
option in other acute respiratory failures like
severe diffuse pneumonia, ALI (acute lung injury)
or even ARDS. However, in spite of recent
promising results, the application of noninvasive
pressure support ventilation in patients
with severe hypoxaemic non-hypercapnic
acute respiratory failure still remains controversial
and potentially predictive of a high
failure rate predominantly in patients with a
coexisting bacteraemia associated with distant
organ dysfunction.