Noninvasive ventilation in treatment of acute respiratory failure in ICU

In the last years noninvasive ventilation (NIV) is used increasingly worldwide in treatment of acute respiratory failure (ARF). The evidence strongly supports NIV use in patients with ARF, especially for chronic obstructive pulmonary disease (COPD) exacerbations and acute cardiogenic pulmonary edema. The efficacy of NIV depends on several factors like the experience of medical team, adequate selection of patient and interface and appropriate ventilator settings. This is a retrospective analysis of patients with ARF treated by NIV in the medical intensive care unit (ICU), University Hospital Sveti Duh, between January 2015 and January 2016. Analysis of statistical hospital data showed steady increments in NIV utilization from year 2011 (7%) to 2015 (15.7%). The mean age of studied patients was 69.8 years, 58.3% were male and 41.7% female. Four major causes for applying NIV were: COPD (41.7%), pneumonia (25%), acute cardiogenic pulmonary edema (19.4%) and other reasons (13.9%). Of 108 patients 93 (86.1%) were successfully treated with NIV and 15 (13.9%) were intubated. A number of randomized clinical trials support the use of NIV in patients with ARF and beside the beneficial role in reducing patients symptoms it showed reduction in morbidity, mortality and length of stay in ICU. Failure rates of NIV still range from 25% to 40%, and optimization of NIV success rates requires careful patient selection and knowledge of proper application and monitoring techniques. If a patient fails to improve sufficiently, prompt endotracheal intubation should be performed without delay.