What is the role of noninvasive positive-pressure ventilation (NIPPV) in the treatment of acute respiratory distress syndrome (ARDS)?

Updated: Mar 27, 2020
  • Author: Eloise M Harman, MD; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

Because intubation and mechanical ventilation may be associated with an increased incidence of complications, such as barotrauma and nosocomial pneumonia, alternatives to mechanical ventilation such as a high-flow nasal cannula or noninvasive positive-pressure ventilation (NIPPV) may be beneficial in patients with ARDS. High-flow nasal cannula uses a system of heated humidification and large-bore nasal prongs to deliver oxygen at flows of up to 50-60 L/min. This is usually used in conjunction with an oxygen blender, allowing delivery of precise inspired oxygen concentrations. High-flow nasal cannula is usually well tolerated and allows the patient to talk, eat, and move around. NIPPV is usually given by full facemask. Sometimes, continuous positive airway pressure (CPAP) alone may be sufficient to improve oxygenation. In a 2015 study on hypoxemic, nonhypercapnic patients comparing standard oxygen, high-flow nasal cannula, and NIPPV, [34] all three modes had the same incidence of need for intubation/mechanical ventilation, but high-flow nasal cannula resulted in improved 90-day mortality.


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