Is there still a place for noninvasive ventilation in acute hypoxemic respiratory failure?

Excerpt

There is strong evidence for the use of noninvasive ventilation (NIV) rather than standard oxygen alone to reduce the reintubation rate in several forms of acute respiratory failure (ARF): acute exacerbation of chronic obstructive pulmonary disease (COPD), cardiogenic pulmonary edema, and hypoxemia post-abdominal surgery [1, 2]. The debate lies in the fact that the majority of patients with acute hypoxemic respiratory failure do not fall into these buckets. NIV (with either positive end-expiratory pressure [PEEP] or continuous positive airway pressure) was until recently considered the gold standard of initial oxygenation strategies. A new method of oxygenation was launched in the 2010s, high-flow nasal cannula oxygen (HFNC), providing a high flow of humidified oxygen, with a low level of PEEP (from 2 to 6 cm H₂O, depending on the flow rate and the opening or closing of the mouth). The FLORALI trial [3] reported in 2015 that NIV was independently associated with increased mortality compared to HFNC in patients with acute hypoxemic ARF. Similar results were observed in the LUNG SAFE multicenter observational study by Bellani et al. [4]. However, in the large cohort study by Demoule et al. [5] investigating trends in NIV use over time, NIV failure in acute hypoxemic ARF was no longer associated with mortality in 2010 and 2011, contrary to the findings of 1997 and 2002. …