Noninvasive Mechanical Ventilation in Acute Hypoxemic Respiratory Failure

Abstract

Noninvasive mechanical ventilation is widely used for acute respiratory failure in a variety of etiologies. The recommended specific conditions were the exacerbation of chronic obstructive pulmonary disease, cardiogenic pulmonary edema, de novo acute hypoxemic respiratory failure, immunocompromized pneumonia, palliation, postoperative period, weaning and postextubation. Pneumonia and acute respiratory distress syndrome are common causes of acute hypoxemic respiratory failure. Noninvasive mechanical ventilation failure is high in this disease group compared to acute hypercapnic respiratory failure. Noninvasive mechanical ventilation can be recommended in patients with mild even in moderate acute respiratory distress syndrome and not in patients with severe acute respiratory distress syndrome. Due to insufficient evidence in patients with pneumonia and acute respiratory distress syndrome, no recommendation can be given for routine use of noninvasive mechanical ventilation. Although some patients benefit from noninvasive mechanical ventilation, they should be used by a team experienced on noninvasive mechanical ventilation in pneumonia and early acute respiratory distress syndrome. A skilled team, proper place, patient and devices can optimize prognosis. There should be a particular attention to shock, multiorgan failure and change of consciousness. Patient selection should be made correctly, considering that mortality can be seen in case of delayed intubation.

Keywords

• community-acquired pneumonia,acute respiratory distress syndrome,non-invasive ventilation

Akut Hipoksemik Solunum Yetmezliğinde Noninvaziv Mekanik Ventilasyon

Abstract

Noninvaziv mekanik ventilasyon akut solunum yetmezliğinin birçok nedenlerinden dolayı yaygın olarak kullanılmaktadır. Bunlar arasında kronik obstrüktif akciğer hastalığı alevlenmesi, kardiyojenik pulmoner ödem, de novo hipoksemik solunum yetmezliği, immün sistemi baskılanmış hastalar, göğüs travması, palyatif amaçlı, ameliyat sonrası bakım, weaning ve ekstübasyon sonrası alevlenme bulunmaktadır. Pnömoni ve akut solunum sıkıntısı sendromu, akut hipoksemik solunum yetmezliğinin sık karşılaşılan nedenleridir. Noninvaziv mekanik ventilasyon başarısızlığı bu hastalık grubunda, akut hiperkapnik solunum yetmezliğine göre yüksektir. Noninvaziv mekanik ventilasyon orta-ağır akut solunum sıkıntısı sendromu hastalarında değil yalnız hafif akut solunum sıkıntısı sendromu olan hastalarda erken dönem tedavide önerilebilir. Pnömoni ve akut solunum sıkıntısı sendromu hastalarında kanıtların yetersiz olmasından dolayı noninvaziv mekanik ventilasyonun rutin kullanımıyla ilgili öneri verilememektedir. Bazı hastalar noninvaziv mekanik ventilasyondan fayda görse de pnömoni ve erken dönem akut solunum sıkıntısı sendromunda noninvaziv mekanik ventilasyon konusunda deneyimli bir ekip tarafından kullanılmalıdır. Yetenekli bir ekip, uygun yer, hasta ve cihazlar prognozu optimize edebilir. Özellikle şok, multiorgan yetmezliği ve bilinç değişikliği gibi durumlara dikkat edilmelidir. Entübasyonda gecikmeye bağlı mortalite görülebileceği göz önünde bulundurularak hasta seçimi doğru yapılmalıdır.

Keywords

• toplum kökenli pnömoni,akut solunum sıkıntısı sendromu,non-invaziv ventilasyon

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