What is the role of noninvasive ventilation (NIV) in the treatment of acute respiratory distress syndrome (ARDS)?

Updated: Jun 18, 2020
  • Author: Guy W Soo Hoo, MD, MPH; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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For acute respiratory distress syndrome, [67, 68]  note the following:

  • Not recommended as first-line therapy in management

  • Limited experience, but may benefit those who do not require immediate intubation

  • Noninvasive ventilation provided via mask or helmet; able to avoid intubation in approximately half - Ventilator settings in successful noninvasive ventilation are pressure support ventilation of 14 cm water; positive end-expiratory (PEEP) of 7 cm water; successfully treated patients found to have lower severity of illness (Simplified Acute Physiology Score II 2</sub>/FiO2 ratio >175 after 1 h)

  • High-flow nasal cannula oxygen in a trial compared with high-flow nasal cannula plus noninvasive face mask ventilation with better mortality outcomes than noninvasive ventilation, although no statistical difference in primary outcome of intubation [69]

  • Single-center trial of selected patients with acute respiratory distress syndrome who did not improve with noninvasive ventilation demonstrated benefit with helmet ventilation with decreased intubation rate, more ventilator-free days, and decreased mortality [70] ; higher PEEP delivered and high flow rates (100-200 L/min) may explain benefit of helmet noninvasive ventilation

For severe acute respiratory distress syndrome, [51, 38]  note the following:

  • Successful treatment with noninvasive ventilation during severe acute respiratory distress syndrome (SARS) outbreak

  • Noninvasive ventilation able to avoid intubation in 70%

  • Patients hypoxemic with also relatively low severity of illness (Acute Physiology and Chronic Health Evaluation II [APACHE II] score <6)

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