Indications for non-invasive ventilation in respiratory failure

Simone Maria Navarra, Maria Teresa Congedo, Mariano Alberto Pennisi

Research output: Contribution to journalReview articlepeer-review


Background: Non-invasive ventilation (NIV) is increasingly being used to treat epi-sodes of acute respiratory failure not only in critical care and respiratory wards, but also in emergency departments. Aim: Aim of this review is to summarize the current indications for the management of NIV for respiratory failure. Methods: Current literature about the topic was reviewed and critically reported to describe the rationale and physiologic advantages of NIV in various situations of respiratory failure. Results: Early NIV use is commonly associated with the significant decrease in endotracheal intu-bation rate, the incidence of infective complications (especially ventilatory associated pneumonia), Intensive Care Units and the length of hospital stay and, in selected conditions, also in mortality rates. Severe acute exacerbation of chronic obstructive pulmonary disease (pH<7.35 and relative hyper-carbia) and acute cardiogenic pulmonary oedema are the most common NIV indications; in these conditions NIV advantages are clearly documented. Not so evident are the NIV benefits in hypox-aemic respiratory failure occurring without prior chronic respiratory disease (De novo respiratory failure). One recent randomized control trial reported in hypoxaemic respiratory failure a survival benefit of high-flow nasal cannulae over standard oxygen therapy and bilevel NIV. Evidence suggests the advantages of NIV also in respiratory failure in immunocompromised patients or chest trauma patients. Use during a pandemic event has been assessed in several observational studies but remains contro-versial; there also is not sufficient evidence to support the use of NIV treatment in acute asthma ex-acerbation. Conclusion: NIV eliminates morbidity related to the endotracheal tube (loss of airway defense mechanism with increased risk of pneumonia) and in selected conditions (COPD exacerbation, acute cardiogenic pulmonary edema, immunosuppressed patients with pulmonary infiltrates and hy-poxia) is clearly associated with a better outcome in comparison to conventional invasive ventila-tion. However, NIV is associated with complications, especially minor complications related to in-terface. Major complications like aspiration pneumonia, barotrauma and hypotension are infre-quent.

Original languageEnglish
Pages (from-to)251-257
Number of pages7
JournalReviews on Recent Clinical Trials
Issue number4
Publication statusPublished - 2020


  • Acute respiratory failure
  • Cardiogenic pulmonary edema
  • Chronic obstructive pulmonary disease
  • Hypoxemia
  • Immunocompromised patients
  • Non-invasive ventilation

ASJC Scopus subject areas

  • Pharmacology


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