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Noninvasive Positive-Pressure Ventilation for Acute Respiratory Failure: Comparative Effectiveness

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Noninvasive Positive-Pressure Ventilation for Managing Acute Respiratory Failure (1 of 3)

Another important option for managing acute respiratory failure in patients who do not need emergent ventilation is noninvasive positive-pressure ventilation (NPPV). NPPV refers to a form of mechanical support in which positive pressure delivers a mixture of air and oxygen via a noninvasive interface.

NPPV can be delivered via a standard intensive care unit ventilator or a portable device. Patient-ventilator interfaces for NPPV include a face mask, a nasal mask, or nasal plugs. Although the face mask may be less comfortable and more difficult to monitor for aspiration, it provides better physiological performance (less resistance to airflow and less air leak) when compared to nasal devices.

The most commonly used modes of NPPV are continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BPAP). CPAP is applied throughout the respiratory cycle of a spontaneously breathing patient. BPAP delivers two pressure levels according to the respiratory cycle and improves ventilation, oxygenation, and alveolar recruitment. BPAP provides both an inspiratory positive airway pressure and a continuous expiratory positive airway pressure.