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Noninvasive ventilation (NIV) improves alveolar hypoventilation and decreases the work of breathing, preventing endotracheal intubation in appropriately selected patients. Available guidelines advocate timely NIV initiation with individualized settings and close monitoring by an experienced healthcare team to ensure favorable outcomes. In the acute care, moderate to severe dyspnea, clinical signs of respiratory distress, hypercapnic respiratory acidosis, and severe hypoxemia unresponsive to conventional oxygen therapy are indications for NIV in the setting of chronic obstructive pulmonary disease, cardiogenic pulmonary edema, obesity hypoventilation syndrome, sleep apnea syndrome, neuromuscular disorders, chest wall deformities, acute respiratory distress syndrome, chest trauma, and immunocompromised or terminal disease state. NIV may also support selected cases during the perioperative, postoperative and post-extubation period or aid in weaning from mechanical ventilation. Patient comfort during NIV should be optimal to prevent intolerance and subsequent NIV failure. Adjustment of NIV settings, fitting interface, prevention of complications, and management of symptoms enhance comfort, while adequate nursing care and physician surveillance within a patient-physician trust relationship inspire confidence and increase patient cooperation. Importantly, persistent patient discomfort may signify lack of response to NIV or even deterioration of underlying disorders, dictating timely intubation. Evaluation of the upper airway is pivotal to identify potential indications for treatment with NIV and explore untoward responses during NIV. Medical history and physical examination can reveal abnormalities that potentially disrupt the upper airway patency. Endoscopy, combined with dynamic tests or performed under sedation, and polysomnography with capnography are useful to titrate NIV settings in cases with inadequate response secondary to upper airway dysfunction. The ultrasound may offer an alternative practical approach that merits standardization for such cases.

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Patient Selection: Score Discomfort and Airway Evaluation

  • 章节

  • 发表日期：

    2025年

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  • Efthymia Papadopoulou,
  • Effimia Kamariotou,
  • Stavros Tryfon

摘要

Noninvasive ventilation (NIV) improves alveolar hypoventilation and decreases the work of breathing, preventing endotracheal intubation in appropriately selected patients. Available guidelines advocate timely NIV initiation with individualized settings and close monitoring by an experienced healthcare team to ensure favorable outcomes. In the acute care, moderate to severe dyspnea, clinical signs of respiratory distress, hypercapnic respiratory acidosis, and severe hypoxemia unresponsive to conventional oxygen therapy are indications for NIV in the setting of chronic obstructive pulmonary disease, cardiogenic pulmonary edema, obesity hypoventilation syndrome, sleep apnea syndrome, neuromuscular disorders, chest wall deformities, acute respiratory distress syndrome, chest trauma, and immunocompromised or terminal disease state. NIV may also support selected cases during the perioperative, postoperative and post-extubation period or aid in weaning from mechanical ventilation. Patient comfort during NIV should be optimal to prevent intolerance and subsequent NIV failure. Adjustment of NIV settings, fitting interface, prevention of complications, and management of symptoms enhance comfort, while adequate nursing care and physician surveillance within a patient-physician trust relationship inspire confidence and increase patient cooperation. Importantly, persistent patient discomfort may signify lack of response to NIV or even deterioration of underlying disorders, dictating timely intubation. Evaluation of the upper airway is pivotal to identify potential indications for treatment with NIV and explore untoward responses during NIV. Medical history and physical examination can reveal abnormalities that potentially disrupt the upper airway patency. Endoscopy, combined with dynamic tests or performed under sedation, and polysomnography with capnography are useful to titrate NIV settings in cases with inadequate response secondary to upper airway dysfunction. The ultrasound may offer an alternative practical approach that merits standardization for such cases.