Intensive Care Medicine

, Volume 37, Issue 8, pp 1250–1257

Palliative noninvasive ventilation in patients with acute respiratory failure

Authors

    • Service de Réanimation MédicaleAPHP, Hôpital Saint-Louis
  • Alexandre Demoule
    • Service de Réanimation MédicaleAPHP, Hôpital Saint-Louis
  • Samir Jaber
    • Service de Réanimation MédicaleAPHP, Hôpital Saint-Louis
  • Achille Kouatchet
    • Service de Réanimation MédicaleAPHP, Hôpital Saint-Louis
  • Anne-Pascale Meert
    • Service de Réanimation MédicaleAPHP, Hôpital Saint-Louis
  • Laurent Papazian
    • Service de Réanimation MédicaleAPHP, Hôpital Saint-Louis
  • Laurent Brochard
    • Service de Réanimation MédicaleAPHP, Hôpital Saint-Louis
Review

DOI: 10.1007/s00134-011-2263-8

Cite this article as:
Azoulay, É., Demoule, A., Jaber, S. et al. Intensive Care Med (2011) 37: 1250. doi:10.1007/s00134-011-2263-8

Abstract

Over the last two decades, the increasing use of noninvasive ventilation (NIV) has diminished the need for endotracheal ventilation, thus decreasing the rate of ventilation-induced complications. Thus, NIV has decreased both intubation rates and mortality rates in specific subsets of patients with acute respiratory failure (e.g., patients with hypercapnia, cardiogenic pulmonary edema, immune deficiencies, or post-transplantation acute respiratory failure). NIV is also increasingly used as a palliative strategy when endotracheal ventilation is deemed inappropriate. In this context, palliative NIV can either be administered to offer a chance for survival, or to alleviate the symptoms of respiratory distress in dying patients. The literature provides information from 10 studies published between 1992 and 2006, in which 458 patients received palliative NIV. The technique was feasible, usually well tolerated, and half of the patients survived. The objectives of this review article are to define palliative NIV, to delineate the place for palliative NIV among overall indications of NIV, and to define the contribution of NIV to the palliative strategies available for patients with acute respiratory failure. Potential benefits and harm from NIV in patients who are not eligible for endotracheal ventilation are discussed. The appropriateness of palliative NIV should be reported in a study that relies on both quantitative criteria (rate of palliative NIV use and mortality) and qualitative criteria (patient comfort, end-of-life process, family burden, and health-care provider satisfaction).

Keywords

ARDS and ALI: clinical studiesCritical care organisationEthicsHematologic–oncologic issues in the ICUNon-invasive ventilationPain management

Copyright information

© Copyright jointly held by Springer and ESICM 2011