Nasal Positive Pressure Ventilation in Patients with Acute Respiratory Failure (1)
Tracheal intubation and mechanical ventilation can successfully provide respiratory support and allow the survival of many patients suffering from acute or acute-on-chronic respiratory failure; however, nasotracheal or orotracheal intubation or tracheostomy may by themselves be a source of added morbidity, and severe complications have been described with these techniques. Furthermore, the endotracheal tube itself may increase the work of breathing and might prolong the duration of weaning from the respirator by inducing inspiratory muscle fatigue. Finally, in some patients, tracheal intubation can be especially dangerous: for instance, immunocompro-mized patients may be at a greater risk of respiratory superinfection when intubated.
Recently, a noninvasive positive-pressure ventilation technique using facial masks without tracheal intubation has been described. The most convincing of these techniques is nasal positive-pressure ventilation (NPPV); a well-tolerated tightly fitted nasal mask is applied on the patients nose. These techniques have been widely used for several years in stable patients with chronic neuromuscular diseases, severe kyphoscoliosis, or central alveolar hypoventilation.”