ADVANTAGES

Avoids complications associated with artificial airways

Provides flexibility in initiating and removing mechanical ventilation

Reduces requirements for heavy sedation

Preserves airway defense, speech, and swallowing mechanisms

Reduces need for invasive monitoring

 

DISADVANTAGES

Can cause gastric distention, skin pressure lesions, facial pain, dry nose, eye irritation, discomfort, claustrophobia, and poor sleep, and mask leaks can occur

Circumstances in Which Noninvasive Positive Pressure Ventilation Should Be Changed to Invasive Ventilation

Respiratory arrest

Respiratory rate >35 breaths/min

Severe dyspnea with use of accessory muscles and possibly paradoxical breathing

Life-threatening hypoxemia: Pa02 <40 mm Hg or Pa02/F I 02 <200

Severe acidosis (pH <7.25) and hypercapnia (PaC02 >60 mm Hg)

Somnolence, impaired mental status

Cardiovascular complications (hypotension, shock, heart failure)

Failure of noninvasive positive pressure ventilation

Other circumstances (e.g., metabolic abnormalities, sepsis, pneumonia, pulmonary embolism, barotrauma, massive pleural effusion)