[Contra: noninvasive ventilation in acute respiratory insufficiency].

Mechanical ventilation via a tracheal tube is an invasive measure whose complications may prevent recovery from respiratory failure. Today, noninvasive positive pressure ventilation via mouthpiece or mask is an economically and medically successful alternative for the treatment of chronic respiratory failure and acute exacerbation of COPD, respectively. Within certain limits, noninvasive ventilation may take over inspiratory work of breathing as well as elevate mean airway pressure and inspiratory oxygen concentration. This does not at all question the absolute indications to maintain a patent airway by tracheal intubation. Clinical applications of noninvasive ventilation within these limits are acute exacerbation of COPD, congestive heart failure with pulmonary edema or atelectasis. Respiratory muscle fatigue, cardiogenic and septic shock, severe pneumonia and ARDS are still absolute indications for invasive ventilation. Table 1 specifies 12 disadvantages and endpoints of noninvasive mechanical ventilation.