Noninvasive Ventilation in Acute Respiratory Distress Syndrome

Abstract

Acute respiratory distress syndrome (ARDS) is the clinical picture of hypoxemic respiratory failure characterized by acute onset, hypoxemia that is unresponsive to oxygen therapy, and bilateral opacities on the chest X-ray. Intubation and lung-protective mechanical ventilation constitute the main treatment strategy for this syndrome. However, noninvasive positive pressure ventilation without endotracheal intubation may be an alternative to this strategy, at least in some patients. Some studies have shown promising results with noninvasive ventilation, although the results are still controversial. In some patients with ARDS who do not show an immediate need for intubation, the success of noninvasive ventilation is closely related to the degree of hypoxemia, the severity of ARDS, and the coexisting physiologic problems and complications. As in all patients with noninvasive ventilation, it should be kept in mind that failure of noninvasive ventilation and delay in intubation can increase the risk of mortality. For this reason, the benefits of noninvasive ventilation and the risk of failure should be evaluated carefully and the clinician should be ready to intubate the patient in the event of failure.