Acute Respiratory Failure and Pulmonary Complications in End-Stage Liver Disease

Nida Qadir, MD; Tisha Wang, MD; Igor Barjaktarevic, MD, PhD; Steven Y. Chang, MD, PhD


Semin Respir Crit Care Med. 2018;39(5):546-555. 

In This Article

Noninvasive Mechanical Ventilation and High-flow Nasal Cannula

Many patients with acute respiratory failure may be managed with high-flow nasal cannula (HFNC) or noninvasive positive-pressure ventilation (NIPPV). HFNC is a noninvasive method of support where heated, humidified oxygen is delivered at high flow rates through a large-bore nasal cannula. It is generally well tolerated, and there is some evidence to suggest that it may decrease the rate of intubation compared to conventional oxygen therapy, although this issue remains controversial.[61–65]

NIPPV involves the delivery of positive-pressure ventilation through a nasal mask, facemask, or nasal plugs. While there is evidence of benefit from its use in chronic obstructive pulmonary disease exacerbations, cardiogenic pulmonary edema, and immunocompromised patients, its role in acute respiratory failure in patients without prior pulmonary disease is unclear.[66] Additionally, contraindications to NIPPV, including the inability to protect the airway, anticipated prolonged duration of mechanical ventilation, and presence of other life-threatening organ failures, frequently preclude its use in ESLD patients.