UMEM Educational Pearls

Category: Critical Care

Title: Noninvasive Ventilation Pearls

Keywords: noninvasive ventilation (PubMed Search)

Posted: 7/15/2008 by Mike Winters, MBA, MD (Updated: 7/13/2024)
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 Noninvasive Ventilation Pearls

  • Multiple studies support the use of noninvasive positive pressure ventilation (NPPV) in acute exacerbations of COPD, acute cardiogenic pulmonary edema, and immunocompromised patients (organ transplant) with hypoxic respiratory failure.
  • The timing of NPPV initiation is important.  NPPV should be started as soon as possible, as delays increase the likelihood of intubation
  • The best predictor of success is a favorable response to NPPV within the first 1 to 2 hours
    • reduction in respiratory rate
    • improvement in pH
    • improved oxygenation
    • reduction in PaCO2
  • Also crucial to NPPV success is a well fitting interface (mask)
  • Although patients report greater comfort with nasal masks, they also permit more air leakage through the mouth and have been associated with a higher rate of initial intolerance in the acute setting.
  • For acute applications of NPPV in the ED, a full face mask is preferred 


Garpestad E, Brennan J, Hill NS. Noninvasive ventilation for critical care. Chest 2007;132:711-20.