One thought on “What Are Considerations for Using NIPPV in ARDS?

  1. Arti says:

     NIPPV was used prior to invasive mechanical ventilation in 32% of patients, of whom 21% eventually failed and required invasive mechanical ventilation. 25. Early evidence suggested that NIPPV lowered the rate of intubation in ARDS and/or acute hypoxemic respiratory failure (Antonelli et al. Patients were divided into two groups: (1) those who received invasive mechanical ventilation initially and (2) those who received NIPPV initially. Importantly, the measurement of delivered and exhaled tidal volumes during NIPPV is unreliable. Furthermore, this literature spans the period during which major advances in ARDS treatment, including low tidal volume ventilation, conservative fluid management, and prone positioning, were being rolled out, making comparison to modern invasive mechanical ventilation strategies challenging. 2017). However, this early evidence consists largely of studies with small sample sizes, single institutional reports, and retrospective cohort designs. The authors posit that these arguably less lung protective ventilation strategies may have been related to delayed recognition of ARDS in patients undergoing NIPPV. 1999; Ferrer et al. Furthermore, the hospital length of stay was similar between the NIPPV failure and invasive mechanical ventilation groups. Furthermore, in a propensity-matched cohort of patients with moderate-severe ARDS (P/F < 150), patients receiving NIPPV had a significantly increased mortality. Rates of NIPPV success i. (avo In another large retrospective cohort study, Taha and colleagues used the National Inpatient Sample to identify 4,227 patients who received positive pressure ventilation during 2016 for ARDS (Taha et al. As one might expect, patients receiving NIPPV had significantly lower levels of PEEP and higher minute ventilation than those who were intubated.  As shown in the figure below, patients for whom NIPPV failed carried a similar mortality rate than those who were intubated initially (26.

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