Which patients should be evaluated on a case-by-case basis before receiving noninvasive ventilation (NIV)?

Updated: Jun 18, 2020
  • Author: Guy W Soo Hoo, MD, MPH; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

The remaining conditions have had reports of successful noninvasive ventilation in both acute and chronic respiratory failure. Most of these processes represent patients with either chronic hypercapnia or relatively mild hypoxemia. Patients with the following diagnoses who may be candidates for noninvasive ventilation should be evaluated on a case-by-case basis:

  • Cystic fibrosis - May be useful as a bridge to lung transplantation and as an adjunct to oxygen therapy alone during sleep to improve gas exchange [72]
  • Neuromuscular respiratory disease [73, 74]  - Nocturnal use may be especially effective for daytime hypercapnia; avoid in bulbar dysfunction or excess secretions; effective in patients with muscular dystrophy, kyphoscoliosis, and postpolio syndrome; some may be able to be treated with negative-pressure ventilators

  • Obesity-hypoventilation (or decompensated obstructive sleep apnea) - Corrects hypercapnia, facilitates diuresis, and provides opportunity for restorative sleep [51]

  • Upper airway obstruction (partial) - Caution if potential for complete obstruction

  • Mild Pneumocystis carinii pneumonia - Case series; may avoid intubation in selected patients

  • Support during invasive procedures - Bronchoscopy, percutaneous gastrostomy [51, 75]

  • Idiopathic pulmonary fibrosis - Generally poor response to invasive ventilation, much less noninvasive ventilation; Successfully treated patients with a rapidly reversible cause of respiratory failure


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