Noninvasive Mechanical Ventilation in High-Dependency Units

Abstract

Noninvasive ventilation (NIV) is a mode of oxygen delivery that reduces or eliminates the need for invasive mechanical ventilation and involves the use of external masks that are attached to a system producing positive pressure ventilation. NIV in the acute setting is commonly used to treat patients with acute hypoxic and/or hypercapnic respiratory failure secondary to underlying conditions such as chronic obstructive pulmonary disease (COPD) exacerbations, cardiogenic pulmonary edema, respiratory muscle weakness like neuromuscular disorders, and other disorders resulting in acute hypoxic respiratory failure. High-dependency units (HDU) or step-down units are specialized units that serve as intermediary units to general wards and intensive care units (ICUs). They have facilities to provide a higher level of care compared to general wards. These units are increasingly being utilized to manage patients requiring NIV in the hospital. Protocols, adequate training, and role-appropriate education of nursing staff, doctors, physical therapists, and respiratory therapists staffing the unit are necessary to ensure the successful management of these patients on the unit.