Treating respiratory failure without intubation
Non-invasive ventilation is a valuable treatment for respiratory failure. Recently it has been employed in non-critical care settings in some UK hospitals and, as such, is often encountered in foundation year 1, especially in respiratory jobs. Non-invasive ventilation receives minimal teaching during undergraduate training, but it is important to have a basic understanding of what it is, how it works, the indications and contraindications, and some practicalities of its use.
Non-invasive ventilation refers to assisted ventilation without the need for an endotracheal tube, tracheostomy, or laryngeal mask airway. It is most commonly administered as positive pressure ventilation (on which this article focuses) via face masks, helmets, or nasal masks. Negative pressure ventilation—for example, using the iron lung—was used to support respiratory paralysis secondary to poliomyelitis and is still used in some specialist units.
Commonly used modes of positive pressure non-invasive ventilation include:
Non-invasive ventilation can be provided by a variety