Clinical Case Database / Category: Clinical Care
Invasive and non-invasive ventilation
Publication details
K Panesar, P E Pfeffer, H Makker
Foundation Years Journal, volume 5, issue 9, p.39 (123Doc Education, London, October 2011)
Abstract
Respiratory failure is one the commonest medical emergencies. Many patients improve with standard medical therapy but some need respiratory support with non-invasive or invasive mechanical ventilation. Bi-level non-invasive ventilation (NIV) is effective if used correctly for type 2 respiratory failure due to the exacerbations of chronic obstructive pulmonary disease but can be dangerous if used inappropriately. The use of NIV in other conditions such as pulmonary oedema is less established. Some of the dangers of NIV can be reduced by appropriate prior consideration of a plan in case NIV fails. Invasive ventilation is another option which protects against some of the problems of NIV but has its own complications. In this article we discuss these issues with reference to two illustrative cases.
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Authors
K Panesar
Clinical Fellow, North Middlesex University Hospital
P E Pfeffer
Specialist Registrar in Respiratory Medicine,
North Middlesex University Hospital
H Makker
Consultant Respiratory Physician, North Middlesex
University Hospital and University College Hospital
References
1. Ram FSF, Picot J, Lightowler J, Wedzicha JA. Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2004, Issue 3.
2. Royal College of Physicians, British Thoracic Society, Intensive Care Society. Chronic obstructive pulmonary disease: non-invasive ventilation with bi-phasic positive airways pressure in the management of patients with acute type 2 respiratory failure. Concise Guidance to Good Practice series, No 11. London: RCP, 2008.
3. Masip J, Roque M, Sanchez B, Fernandez R, Subirana M, Exposito JA. Noninvasive ventilation in acute cardiogenic pulmonary edema. Systematic Review and Meta-analysis. JAMA 2005;294:3124-30
4. Gray AJ, Goodacre S, Newby DE, Masson MA, Sampson F, Dixon S, et al., on behalf of the 3CPOstudy investigators. A multicentre randomised controlled trial of the use of continuous positive airway pressure and non-invasive positive pressure ventilation in the early treatment of patients presenting to the emergency department with severe acute cardiogenic pulmonary oedema: the3CPO trial. Health Technol Assess 2009;13(33).
5. Jolliet P, Abajo B, Pasquina P, Chevrolet J. Non-invasive pressure support ventilation in severe community-acquired pneumonia. Intensive Care Med 2001;27:812-21
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About the Clinical Cases Database
The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
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