Noninvasive Ventilation

Excerpt

Non-invasive ventilation (NIV) was first reported in the mid-eighteen century by a Scottish physician, John Dalziel. In 1864, Alfred F. Jones' patented the first American tank respirator in the iron lung, known as non-invasive negative pressure ventilation. In 1938 a new form of NIV was described by Barach et al. as a treatment for pulmonary edema. However, Oertel described the use of intermittent positive pressure (NPPV) earlier by Oertel (1878).

During the polio epidemic and due to very high mortality (more than 80%), innovation was sparked by physicians such as Bjorn Ibsen, an anesthesiologist from Copenhagen, Denmark, who applied positive pressure ventilation in 1952 via trach but required manual delivery. The approach dropped the mortality by more than half (to nearly 40%); however, the delivery of pressure was a logistical problem, as there were no positive pressure ventilators, and patients needed to be bagged by hand.

Over the past century, positive pressure ventilation (NPPV) has been dramatically improved and used to treat respiratory failure from multiple etiologies. It has been proven effective in preventing intubation compared to standard oxygen therapy in the acute setting. NPPV encompasses several methods of respiratory support, the most common being Bilevel Positive Airway Pressure (BPAP).

The latest American Thoracic Society/European Respiratory Journal guidelines support the use of NPPV in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and acute respiratory failure secondary to cardiogenic pulmonary edema, where evidence and level of recommendation are the strongest. However, there is a body of evidence and conditional recommendations that NPPV is effective in other settings of acute respiratory failure, such as post-operative and chest trauma. In addition, several studies support the use of NPPV in various chronic respiratory diseases.