Noninvasive positive pressure ventilation

1. Noninvasive positive pressure ventilation
Indications
(strongest
evidence)
• COPD (severe exacerbation, prevent extubation failure)
• Cardiogenic pulmonary edema
• Acute respiratory failure
• Postoperative hypoxemic respiratory failure
• Immunosuppressed patients
• Facilitate early extubation
Contraindications
Medical instability
• Cardiac or respiratory arrest (or impending arrest)
• Severe acidosis (pH <7.1)
• Acute respiratory distress syndrome
• Nonrespiratory organ failure
• Unstable cardiac arrhythmia/hemodynamic instability
• Encephalopathy (Glasgow Coma Score <10)
• Gastrointestinal bleed
Inability to protect airway
• Uncooperative or agitated
• Inability to clear secretions/high aspiration risk
Mechanical issues
• Recent esophageal anastomosis
• Facial or neurologic surgery, deformity, or trauma
• Upper airway obstruction