Timing of noninvasive ventilation failure: causes, risk factors, and potential remedies

BMC Pulmonary Medicine

Stefano Nava¹  Aylin Ozsancak Ugurlu²  Ezgi Ozyilmaz³ 

[1] Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), Respiratory and Critical Care, University of Bologna, Sant'Orsola Malpighi Hospital building #15, Alma Mater Studiorum, via Massarenti n.15, Bologna 40185, Italy;Baskent University Faculty of Medicine Department of Pulmonary Disease, İstanbul, Turkey;Cukurova University Faculty of Medicine Department of Pulmonary Disease, Adana, Turkey

关键词: Respiratory insufficiency;    Treatment failure;    Noninvasive ventilation;   

Others  :  865430
DOI  :  10.1186/1471-2466-14-19

 received in 2013-10-10, accepted in 2014-01-29,  发布年份 2014

【 摘 要 】

Background

Identifying the predictors of noninvasive ventilation (NIV) failure has attracted significant interest because of the strong link between failure and poor outcomes. However, very little attention has been paid to the timing of the failure. This narrative review focuses on the causes of NIV failure and risk factors and potential remedies for NIV failure, based on the timing factor.

Results

The possible causes of immediate failure (within minutes to <1 h) are a weak cough reflex, excessive secretions, hypercapnic encephalopathy, intolerance, agitation, and patient-ventilator asynchrony. The major potential interventions include chest physiotherapeutic techniques, early fiberoptic bronchoscopy, changing ventilator settings, and judicious sedation. The risk factors for early failure (within 1 to 48 h) may differ for hypercapnic and hypoxemic respiratory failure. However, most cases of early failure are due to poor arterial blood gas (ABGs) and an inability to promptly correct them, increased severity of illness, and the persistence of a high respiratory rate. Despite a satisfactory initial response, late failure (48 h after NIV) can occur and may be related to sleep disturbance.

Conclusions

Every clinician dealing with NIV should be aware of these risk factors and the predicted parameters of NIV failure that may change during the application of NIV. Close monitoring is required to detect early and late signs of deterioration, thereby preventing unavoidable delays in intubation.

【 授权许可】

   
2014 Ozyilmaz et al.; licensee BioMed Central Ltd.

【 图 表 】

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