Respiratory Failure and Non-invasive Ventilation

Abstract

Respiratory failure results from a failure of pulmonary gas exchange caused by many processes that affect the delivery of oxygen to alveoli and pulmonary circulation, and in some cases, the clearance of carbon dioxide. The spectrum of pathophysiological mechanisms is described in this chapter. The use of non-invasive ventilation (NIV) in acute exacerbations of chronic obstructive pulmonary disease (COPD) is now established practice, but its use in type 1 respiratory failure caused by pneumonia, accute respiratory distress syndrome (ARDS), pulmonary fibrosis, and cardiogenic pulmonary oedema is less well defined. Domiciliary NIV is effective in patients with obesity, chest wall deformity, and slowly progressive neuromuscular disease, and use has recently been extended to more rapidly progressive neurological disease such as Duchenne muscular dystrophy and motor neurone disease. Potentially the largest group with type 2 respiratory failure is severe COPD, but until recently the benefits of home mechanical ventilation have been unproven. Recent work suggests more aggressive ventilatory strategies in carefully selected subgroups may impact on readmission and mortality.