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Noninvasive Positive-Pressure Ventilation for Acute Respiratory Failure: Comparative Effectiveness

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Background: Acute Respiratory Failure and Its Prevalence

Respiratory failure is a syndrome characterized by the inability to maintain normal exchange of oxygen and carbon dioxide due to dysfunction of the respiratory system. There are two types of respiratory failure: type I is characterized by low partial pressure of oxygen in arterial blood (PaO2) with normal or low partial pressure of carbon dioxide in arterial blood (PaCO2), and type II is characterized by high PaCO2. Respiratory failure is termed acute when it develops over minutes or several days. For the purpose of this review, acute respiratory failure is defined as a significant change in a patient’s baseline gas-exchange status (given the constellation of available clinical data) that occurs relatively suddenly (usually hours to days) and is potentially life threatening but does not require emergent intubation.

The annual incidence of acute respiratory failure is estimated to be between 77.6 and 430 patients per 100,000. It is the most common reason for admission to the intensive care unit in the United States. The estimated health care costs related to critical care are approximately 0.7 percent of the annual gross domestic product, and the human and financial costs are expected to increase with an aging population.

Several conditions that affect the functioning of the respiratory system can lead to acute respiratory failure including chronic obstructive pulmonary disease, acute cardiogenic pulmonary edema, pneumonia, acute respiratory distress syndrome, asthma, obesity hypoventilation syndrome, and interstitial lung disease.