Patients with acute respiratory failure frequently require endotracheal intubation and mechanical ventilation (invasive positive pressure ventilation) to sustain life. Complications of mechanical ventilation include respiratory muscle weakness, upper airway pathology, ventilator associated pneumonia and associated deaths and sinusitis. For these reasons it is important to minimize the duration of mechanical ventilation. Noninvasive positive pressure ventilation is achieved with an oronasal, nasal or total face mask connected to a ventilator and does not require an indwelling artificial airway.
Results from 12 randomized controlled trials demonstrated that for 530 selected patients (predominantly with chronic obstructive pulmonary disease) who had respiratory failure and were starting to breathe spontaneously, showed that noninvasive ventilation could decrease deaths, pneumonia, length of stay in the intensive care and hospital and the duration of ventilator support. Noninvasive weaning demonstrated no effect on weaning failures and the duration of mechanical ventilation related to weaning. Insufficient data were available to assess adverse events or the impact of noninvasive weaning on quality of life. Further trials are required to determine the overall clinical benefits, risks and consequences associated with the use of noninvasive weaning.