Noninvasive Ventilation in Acute Lung Injury/Acute Respiratory Distress Syndrome

  • Ritesh AgarwalEmail author


The acute respiratory distress syndrome (ARDS) is a clinical syndrome of lung injury characterized by severe dyspnea, refractory hypoxemia, and bilateral radiographic opacities. It is clinically defined by the following criteria: acute onset (less than 7 days), bilateral alveolar opacities consistent with pulmonary edema, Pao2/Fio2 < 200, pulmonary artery occlusion pressure less than 18 mmHg, or no clinical evidence of left atrial hypertension [1]. It is now recognized that there is a gradation of the severity of clinical lung injury: patients with less-severe hypoxemia (defined by a Pao2/Fio2 ratio of 300 or less) are considered to have acute lung injury (ALI), and those with more severe hypoxemia (defined by a Pao2/Fio2 ratio of 200 or less) are considered to have ARDS [1]. The mainstay of treatment for patients with ALI/ARDS is intubation and mechanical ventilation. However, endotracheal intubation is associated with significant morbidity, including upper airway trauma, barotrauma, and pneumonia [2–4]. As a result, any intervention that obviates the need for endotracheal intubation in ALI/ARDS is welcome.


Continuous Positive Airway Pressure Acute Respiratory Distress Syndrome Endotracheal Intubation Acute Respiratory Failure Simplify Acute Physiology Score 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Bernard GR, Artigas A, Brigham KL et al (1994) The American–European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149:818–824PubMedGoogle Scholar
  2. 2.
    Stauffer JL, Olson DE, Petty TL (1981) Complications and consequences of endotracheal intubation and tracheotomy. A prospective study of 150 critically ill adult patients. Am J Med 70:65–76PubMedCrossRefGoogle Scholar
  3. 3.
    Pingleton SK (1988) Complications of acute respiratory failure. Am Rev Respir Dis 137:1463–1493PubMedGoogle Scholar
  4. 4.
    Fagon JY, Chastre J, Hance AJ et al (1993) Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med 94:281–288PubMedCrossRefGoogle Scholar
  5. 5.
    Brochard L (2002) Noninvasive ventilation for acute respiratory failure. JAMA 288: 932–935PubMedCrossRefGoogle Scholar
  6. 6.
    Brochard L, Mancebo J, Elliott MW (2002) Noninvasive ventilation for acute respiratory failure. Eur Respir J 19:712–721PubMedCrossRefGoogle Scholar
  7. 7.
    Agarwal R, Aggarwal AN, Gupta D et al (2005) Non-invasive ventilation in acute cardiogenic pulmonary oedema. Postgrad Med J 81:637–643PubMedCrossRefGoogle Scholar
  8. 8.
    Ram FS, Wellington S, Rowe BH et al (2005) Non-invasive positive pressure ventilation for treatment of respiratory failure due to severe acute exacerbations of asthma. Cochrane Database Syst Rev. CD004360Google Scholar
  9. 9.
    L’Her E, Deye N, Lellouche F et al (2005) Physiologic effects of noninvasive ventilation during acute lung injury. Am J Respir Crit Care Med 172:1112–1118PubMedCrossRefGoogle Scholar
  10. 10.
    Antonelli M, Conti G, Rocco M et al (1998) A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure. N Engl J Med 339:429–435PubMedCrossRefGoogle Scholar
  11. 11.
    Delclaux C, L’Her E, Alberti C et al (2000) Treatment of acute hypoxemic nonhypercapnic respiratory insufficiency with continuous positive airway pressure delivered by a face mask: a randomized controlled trial. JAMA 284:2352–2360PubMedCrossRefGoogle Scholar
  12. 12.
    Hilbert G, Gruson D, Vargas F et al (2000) Noninvasive continuous positive airway pressure in neutropenic patients with acute respiratory failure requiring intensive care unit admission. Crit Care Med 28:3185–3190PubMedCrossRefGoogle Scholar
  13. 13.
    Antonelli M, Conti G, Moro ML et al (2001) Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: a multi-center study. Intensive Care Med 27:1718–1728PubMedCrossRefGoogle Scholar
  14. 14.
    Confalonieri M, Calderini E, Terraciano S et al (2002) Noninvasive ventilation for treating acute respiratory failure in AIDS patients with Pneumocystis carinii pneumonia. Intensive Care Med 28:1233–1238PubMedCrossRefGoogle Scholar
  15. 15.
    Cheung TM, Yam LY, So LK et al (2004) Effectiveness of noninvasive positive pressure ventilation in the treatment of acute respiratory failure in severe acute respiratory syndrome. Chest 126:845–850PubMedCrossRefGoogle Scholar
  16. 16.
    Rana S, Jenad H, Gay PC et al (2006) Failure of non-invasive ventilation in patients with acute lung injury: observational cohort study. Crit Care 10:R79PubMedCrossRefGoogle Scholar
  17. 17.
    Antonelli M, Conti G, Esquinas A et al (2007) A multiple-center survey on the use in clinical practice of noninvasive ventilation as a first-line intervention for acute respiratory distress syndrome. Crit Care Med 35:18–25PubMedCrossRefGoogle Scholar
  18. 18.
    Yoshida Y, Takeda S, Akada S et al (2008) Factors predicting successful noninvasive ventilation in acute lung injury. J Anesth 22:201–206PubMedCrossRefGoogle Scholar
  19. 19.
    Agarwal R, Handa A, Aggarwal AN et al (2009) Outcomes of noninvasive positive pressure ventilation in acute hypoxemic respiratory failure in a respiratory ICU in North India. Respir Care 54:1679–1687Google Scholar
  20. 20.
    Ferrer M, Esquinas A, Leon M et al (2003) Noninvasive ventilation in severe hypoxemic respiratory failure: a randomized clinical trial. Am J Respir Crit Care Med 168:1438–1444PubMedCrossRefGoogle Scholar
  21. 21.
    Adda M, Coquet I, Darmon M et al (2008) Predictors of noninvasive ventilation failure in patients with hematologic malignancy and acute respiratory failure. Crit Care Med 36: 2766–2772PubMedCrossRefGoogle Scholar
  22. 22.
    Keenan SP, Sinuff T, Cook DJ et al (2004) Does noninvasive positive pressure ventilation improve outcome in acute hypoxemic respiratory failure? A systematic review. Crit Care Med 32:2516–2523PubMedCrossRefGoogle Scholar
  23. 23.
    Agarwal R, Gupta D, Handa A et al (2005) Noninvasive ventilation in ARDS caused by Mycobacterium tuberculosis: report of three cases and review of literature. Intensive Care Med 31:1723–1724PubMedCrossRefGoogle Scholar
  24. 24.
    Agarwal R, Nath A, Gupta D (2007) Noninvasive ventilation in Plasmodium vivax related ALI/ARDS. Intern Med 46:2007–2011PubMedCrossRefGoogle Scholar
  25. 25.
    Antonelli M, Conti G, Bufi M et al (2000) Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial. JAMA 283:235–241PubMedCrossRefGoogle Scholar
  26. 26.
    Agarwal R, Reddy C, Aggarwal AN et al (2006) Is there a role for noninvasive ventilation in acute respiratory distress syndrome? A meta-analysis. Respir Med 100:2235–2238PubMedCrossRefGoogle Scholar
  27. 27.
    Festic E, Gajic O, Limper AH et al (2005) Acute respiratory failure due to pneumocystis pneumonia in patients without human immunodeficiency virus infection: outcome and associated features. Chest 128:573–579PubMedCrossRefGoogle Scholar
  28. 28.
    Wysocki M, Tric L, Wolff MA et al (1995) Noninvasive pressure support ventilation in patients with acute respiratory failure. A randomized comparison with conventional therapy. Chest 107:761–768PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  1. 1.Department of Pulmonary MedicinePostgraduate Institute of Medical Education and ResearchChandigarhIndia

Personalised recommendations