Ventilatory support alternatives to tracheostomy and intubation: current status of the application of this technology.

Intermittent positive pressure ventilation (IPPV) via tracheostomy has been the most common method of providing long-term ventilatory support since the late 1950s. Likewise, intubation for the delivery of IPPV is standard treatment for acute ventilatory failure. Because of poor patient acceptance of elective tracheostomy, numerous reports of complications by these invasive methods, and the recent development of noninvasive ventilatory assistance by intermittent positive airway pressure (NV-PAP), there has been increasing interest in all forms of noninvasive ventilatory support. This report reviews the current application of noninvasive ventilatory support alternatives in both the acute and long-term settings. Assistive technology for the noninvasive evacuation of airway secretions, which facilitates up to 24-hour, long-term noninvasive ventilatory support is also discussed. We conclude that wider familiarity with and application of these techniques are warranted.