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

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Background: Invasive Ventilation for the Management of Acute Respiratory Failure

The initial step in managing respiratory failure is identifying the etiology and determining the need for emergent ventilation. Emergent invasive ventilation is indicated in patients with cardiac arrest or shock, apnea, and a need for airway protection (e.g., coma or seizures). For patients who do not require emergent ventilation, supportive care with supplemental oxygen and/or medications (e.g., antibiotics, corticosteroids, beta-agonists, diuretics) are key strategies in managing acute respiratory failure. However, these conservative strategies are frequently insufficient in preventing further deterioration and death.

In severe cases of acute respiratory failure, respiratory support is required. Invasive ventilation (also known as conventional mechanical ventilation) is a form of respiratory support in which positive pressure delivers a mixture of air and oxygen through an endotracheal or tracheostomy tube to central airways. There are several modes/methods of invasive ventilation with variable levels of respiratory support that can be provided, thereby allowing individualization of the treatment plan.

Despite the life-saving potential of invasive ventilation in patients with respiratory failure, up to 40 percent of patients die in the hospital; some of these deaths are directly attributable to the complications of invasive ventilation and artificial airways. Additionally, many survivors of acute respiratory failure require prolonged invasive ventilation and suffer decrements in quality of life and functional independence.