Noninvasive positive pressure ventilation for acute respiratory failure.

NPPV is useful in decreasing the intubation rate in carefully selected patients with acute respiratory failure. This is particularly the case for patients with COPD. The results of some studies also suggest a survival benefit for use of NPPV with acute respiratory failure associated with COPD. More severely ill patients and those with excessive secretions, altered neurological status, or hemodynamic compromise may be less likely to successfully respond to NPPV. The initial PaCO2 change and mask tolerance may be predictors of success. It is unknown whether technical issues such as type of ventilator, choice of pressure versus volume ventilation, and nasal versus full facial mask affect outcome for NPPV. Although initiation of mask ventilation may be labor intensive, this effort may add value by avoiding the morbidity and mortality associated with intubation.