8(th) International conference on management and rehabilitation of chronic respiratory failure: the long summaries – Part 3

Ambrosino, Nicolino; Casaburi, Richard; Chetta, Alfredo; Clini, Enrico; Donner, Claudio F.; Dreher, Michael; Goldstein, Roger; Jubran, Amal; Nici, Linda; Owen, Caroline A.; Rochester, Carolyn; Tobin, Martin J.; Vagheggini, Guido; Vitacca, Michele; ZuWallack, Richard

The use of non invasive ventilation (NIV) is an option in acute hypercapnic respiratory failure, cardiogenic pulmonary oedema, acute respiratory distress syndrome (ARDS), community-acquired pneumonia, and weaning failure Evidence supports NIV during complicated bronchoscopy, some cases of transoesophageal echocardiography, and in some interventional cardiology NIV can reduce the need for deep sedation or general anaesthesia NIV should be considered with caution in severe communicable airborne infections likely to progress to ARDS The role of assisted ventilation during exercise training is still controversial NIV should be applied under close monitoring, and endotracheal intubation should be promptly available in the case of failure. A trained team, careful patient selection and optimal choice of devices, can optimize outcome of NIV Non invasive ventilation (NIV) may be considered as one of the most important advances in respiratory medicine over the past 20 years, [8, 9] and is increasingly being utilized world-wide [10] . A PubMed search from January 1966 to March 2015 with the term "non invasive ventilation" defines NIV as "any form of ventilatory support applied without endotracheal intubation (ETI)". There is strong evidence (Level A) for the use of NIV to prevent ETI in acute on chronic respiratory failure, acute cardiogenic pulmonary oedema, and to facilitate extubation in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD). Less evidence supports the use of NIV for patients with severe acute asthma exacerbations, post-operative or post-extubation acute respiratory failure (ARF), pneumonia, or acute respiratory distress syndrome (ARDS) [8, 9] . Nevertheless, many other potential applications have been proposed [12] . This review will focus on potential new indications for NIV. Although potentially risky, bronchoscopy may be required for some severely hypoxaemic patients [13] . In the past, the American Thoracic Society (ATS) did not recommend flexible bronchoscopy and bronchoalveolar lavage (BAL) in such conditions when supplemental oxygen cannot correct an arterial oxygen tension (PaO 2 ) at least to 75 mmHg or an arterial oxygen saturation (SaO 2 ) to 90 % [14] . On the other hand, non-use of bronchoscopy in these high risk patients may result in less effective, empiric treatment. Until recently, when bronchoscopy wws needed in hypoxaemic conditions, only ETI and mechanical ventilation were available to provide adequate ventilation and oxygenation. Unfortunately, invasive mechanical ventilation is associated with complications related to ETI, baro-or volutrauma, and the loss of airway defense mechanisms. NIV has the potential to avoid these complications while ensuring a similar level of ventilatory efficacy and control of hypoxemia.