Management of acute respiratory failure with noninvasive ventilation in the emergency department

Ayuso Baptista F, Jiménez Moral G, Fonseca Del Pozo FJ

Noninvasive ventilation (NIV) offers the emergency physician a way to provide initial

support for the patient with acute respiratory failure. Application of NIV in emergency

care settings can have a decisive effect on clinical course. Clear advantages that

conclusively support the use of NIV over invasive mechanical ventilation include the

preservation of the cough reflex and the patient’s ability to talk and eat; furthermore,

NIV avoids invasion of the airway, with all the associated complications that implies.

Recent years have seen the publication of many studies whose results encourage the

early application of NIV in appropriately selected patients. Following the appearance of

the consensus statements of the American Thoracic Society in 2001 and the British

Thoracic Society in 2002, in which various modes of NIV were included in the

therapeutic arsenal for managing either hypoxemic or hypercapnic acute respiratory

failure, NIV use has spread in hospital emergency and ambulance services. Likewise, it is

being used increasingly for home treatment of patients with chronic respiratory failure.

In the immediate future, the challenge will be to train emergency department staff, to

equip them with essential pathophysiologic concepts and the skills for managing acute

respiratory failure, while preserving the chain of care by creating consensus on protocols

to govern interdepartmental responsibilities.

Ayuso Baptista F, Fonseca Del Pozo FJ, Jiménez Moral G