Respir Care. 2014 Apr;59(4):609-12. doi: 10.4187/respcare.03157.
Autore: Raffaele Scala
Apart from the clinical conditions that require immediate ventilator support, conventional oxygen therapy (COT) via a face mask or nasal cannula is considered the “first-step approach” in the escalating therapy for the management of acute respiratory failure (ARF) to buy time for the etiologic therapy to reverse the triggering cause of the acute decompensation. Once physicians realize that only COT is not enough to properly and quickly correct the impaired lung gas exchange and to reduce the burden of respiratory distress, noninvasive ventilation (NIV) becomes the next option, the aim of which is to avoid the need for invasive mechanical ventilation and to prevent its life-threatening complications. Conversely, when an intubated and invasively ventilated patient is ready to be extubated, the transition from being assisted mechanically to spontaneous breathing on COT may be facilitated by the application of NIV, especially in some categories of subjects with underlying chronic cardiopulmonary diseases. Outside the do-not-intubate setting, the failure of noninvasive strategies (COT and NIV) in escalating and de-escalating pathways leads to mandatory invasive mechanical ventilation via endotracheal intubation and re-intubation, respectively.