Series 0noninvasive Ventilation in Acute and Chronic Respiratory

Equipment needs for noninvasive mechanical ventilation. B. Schönhofer, S. Sortor-Leger. #ERS Journals Ltd 2002. ABSTRACT: Noninvasive mechanical ventilation (NIV) has a long tradition for the treatment of chronic respiratory failure and more recently has also been applied in acute respiratory failure. Based on this experience both critical care ventilators and portable ventilators are used to perform NIV. The individual choice of ventilator type should depend on the patient9s condition and also on the expertise of attending staff, therapeutic requirements and the location of care. The majority of studies have used pressure-targeted ventilation in the assist mode. Positive qualities of pressure support ventilation (PSV) are leak compensation, good patient/ventilator synchrony and the option of integrated positive end-expiratory pressure to counteract the effect of dynamic hyperinflation. In this article, some crucial issues concerning PSV (i.e. triggering into inspiration, pressurisation, cycling into expiration and carbon dioxide rebreathing) and some corrective measures are discussed. The parameters which should be monitored during noninvasive ventilation are presented. The interface between patient and ventilator is a crucial issue of noninvasive ventilation. Advantages and disadvantages of face and nasal masks are discussed. Finally, causes and possible remedies of significant air leaks and some technical accessories for noninvasive ventilation are dealt with. Eur Respir J 2002; 20: 1029–1036. *Division of Pulmonary and Critical Care Medicine, Edward Hines, Jr., VA Hospital and Loyola University of Chicago, Hines, IL, USA. St. Didier au mont d9Or, France.