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Non-invasive Ventilation in Acute and Chronic Obstructive Pulmonary Disease

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Non-invasive Mechanical Ventilation in Critical Care, Anesthesiology and Palliative Care

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Abstract

The utility of NIV in acute hypercapnic respiratory failure in COPD and ASMA is well-established and is included in the most recent international guidelines. Noninvasive approaches use a variety of mechanisms to restore the balance of the supply and demand of breathing work.

Indications for NIV in COPD are: tachypnea or increased work of breathing despite treatment with supplemental oxygen and nebulized bronchodilators; acute respiratory acidosis on blood gas analysis (pH <7.35; PaCO2 >45 mmHg); mild alteration in mental status, which is attributed solely to hypercapnia. Contraindications to NIV include hemodynamic instability or cardiopulmonary arrest; altered mental status not attributable to hypercapnia alone; poor secretion clearance, hemoptysis, active vomiting, upper gastrointestinal bleeding, or other airway compromise; recent facial surgery or trauma. Treatment with NIV has been shown to have reduce risks of mortality and endotracheal intubation, and hospital length of stay.

It is important to have markers to predict NIV failure prior to initiation of therapy, to either provide more intensive treatment in the form of invasive mechanical ventilation or allow a more conservative approach, if palliation is the most appropriate strategy.

In Asthma NIV is used, together with conventional pharmacological treatment, with the aim to decrease the respiratory muscle work that is much increased during the episodes of acute bronchoconstriction, off-setting intrinsic PEEP, alveolar recruitment, and to improve ventilation/perfusion mismatch, decrease the sensation of dyspnea, and ultimately avoid intubation and invasive mechanical ventilation. Caution should be exercised because some patients with severe asthma can deteriorate rapidly and develop very-severe obstruction, which makes ventilation difficult, even via the invasive route. If endotracheal intubation is inevitable, this should be performed immediately and without delay. It is therefore important that a trial of NIV is performed in an ICU setting by experienced personnel where endotracheal intubation can be performed quickly.

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Authors and Affiliations

  1. Department of Anesthesia and Intensive Care, Gemelli Molise Hospital, Campobasso, Italy

    G. Castellano & L. Palumbo

  2. Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, Italy

    A. Marra & Giuseppe Servillo

  3. Clinical Pharmacy Gemelli Molise Hospital, Campobasso, Italy

    M. Melchionna

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  1. G. Castellano
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  2. A. Marra
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  3. L. Palumbo
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  4. M. Melchionna
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  5. Giuseppe Servillo
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Editors and Affiliations

  1. Neurosc, Reprod, Odontostomatol Sc, University of Naples “Federico II”, Naples, Italy

    Giuseppe Servillo

  2. Neurosc, Reprod, Odontostomatol Sc, University of Naples “Federico II”, Naples, Italy

    Maria Vargas

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Castellano, G., Marra, A., Palumbo, L., Melchionna, M., Servillo, G. (2023). Non-invasive Ventilation in Acute and Chronic Obstructive Pulmonary Disease. In: Servillo, G., Vargas, M. (eds) Non-invasive Mechanical Ventilation in Critical Care, Anesthesiology and Palliative Care. Springer, Cham. https://doi.org/10.1007/978-3-031-36510-2_10

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  • DOI: https://doi.org/10.1007/978-3-031-36510-2_10

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