Respiratory monitoring is a prerequisite for safe noninvasive ventilation

Abstract

Noninvasive ventilation (NIV) is an effective respiratory support for some patients with respiratory failure. Timely NIV application can help some patients avoid invasive mechanical ventilation (IMV) and its adverse effects, and thus shorten their length of stay in the ICU. NIV use became more frequent during the last 20 years and has been proven as a method of choice for a number of indications. NIV became very popular during the COVID-19 pandemic and was used all over the world. Main goals of this paper are to emphasize respiratory monitoring as a prerequisite for safe NIV application and to warn clinicians of the importance of high respiratory rate and huge inspiratory effort as clinical signs of high work of breathing (WOB). Regardless of the primary cause of lung injury, high WOB further impairs respiratory failure by self-inflicted lung injury (P-SILI). Indirect signs of high WOB, such as high tidal volume (VT), negative swings on airway pressure curve (Paw), high airway occlusion pressure (P0.1) and high driving pressure are discussed as predictors of P-SILI. High WOB attenuation and its control is challenging in all spontaneously breathing patients, whether their respiratory support is invasive or noninvasive. Based on published knowledge and our own experience during long lasting NIV use in different clinical situations, we tried to point out options for high WOB control. NIV is safe only under conditions of strict respiratory monitoring, high WOB control and good knowledge of NIV as a method of respiratory support. In such cases NIV failure will be recognized and a switch to IMV will be performed on time.