Timing of noninvasive ventilation failure: causes, risk factors, and potential remedies
Open accessAbstract
BACKGROUND: Identifying the predictors of noninvasive ventilation (NIV) failure has attracted significant interest because of the strong link between failure and poor outcomes. However, very little attention has been paid to the timing of the failure. This narrative review focuses on the causes of NIV failure and risk factors and potential remedies for NIV failure, based on the timing factor. RESULTS: The possible causes of immediate failure (within minutes to <1 h) are a weak cough reflex, excessive secretions, hypercapnic encephalopathy, intolerance, agitation, and patient-ventilator asynchrony. The major potential interventions include chest physiotherapeutic techniques, early fiberoptic bronchoscopy, changing ventilator settings, and judicious sedation. The risk factors for early failure (within 1 to 48 h) may differ for hypercapnic and hypoxemic respiratory failure. However, most cases of early failure are due to poor arterial blood gas (ABGs) and an inability to promptly correct them, increased severity of illness, and the persistence of a high respiratory rate. Despite a satisfactory initial response, late failure (48 h after NIV) can occur and may be related to sleep disturbance. CONCLUSIONS: Every clinician dealing with NIV should be aware of these risk factors and the predicted parameters of NIV failure that may change during the application of NIV. Close monitoring is required to detect early and late signs of deterioration, thereby preventing unavoidable delays in intubation.
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Previous studies suggested that misuse or rejection of medication or NIV can be influenced by psychological factors such as anxiety, depression, health beliefs, and cognitive impairment.
“Previous studies suggested that the misuse or rejection of medication or NIV can be influenced by some psychological factors such as anxiety, depression, health beliefs, and cognitive impairment (27–29); the unacknowledged recognition of the illness; and the use of different devices and medications due to comorbidities (30–32).”
From Promoting Acceptance and Adherence to Noninvasive Ventilation in Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. (2022) · cites this paper as [31]
The Review’s ‘Patient related risk factors’ section identifies confusion and psychomotor agitation as contributors to poor NIV compliance or intolerance. It does not address medication misuse or rejection, or identify anxiety, depression, or health beliefs as influences. Page numbers are unavailable in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredNo study has identified the individual psychological factors that increase the risk of rejection or improper use of NIV.
“No study has identified the individual psychological factors that increase the risk of rejection or improper use of NIV.”
From A psychological intervention to promote acceptance and adherence to non-invasive ventilation in people with chronic obstructive pulmonary disease: study protocol of a randomised controlled trial. (2017) · cites this paper as [31]
The Review’s “Intolerance and psychomotor agitation” section identifies patient tolerance and agitation as relevant to NIV failure. It does not say whether studies have identified individual psychological factors that increase rejection or improper use of NIV; searches for those terms found no such statement in our copy. (LLM, conf=0.76)
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- Authors
- Ozyilmaz, E., Ugurlu, A. O., & Nava, S.
- Affiliations
- IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT)
- Corresponding author
- Nava, Stefano
- Venue
- BMC Pulmonary Medicine
- Published
- 2014-02-13
- Volume
- 14
- Issue
- 1
- Pages
- 19-19
- ISSN
- 1471-2466 (ISSN-L)
- PMC
- PMC3925956
- OpenAlex
- W2041987026
- Cited by
- 260
- References
- 82
- Citations by year
- 2026: 11 · 2025: 17 · 2024: 18 · 2023: 34 · 2022: 33 · 2021: 23 · 2020: 27 · 2019: 27 · 2018: 18 · 2017: 13 · 2016: 18 · 2015: 16 · 2014: 4
- FWCI
- 2.91
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Pulmonary Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
- Keywords
- noninvasive ventilation failure, risk factors, patient-ventilator asynchrony, hypoxemic respiratory failure, sedation, bronchoscopy, chest physiotherapy, arterial blood gas monitoring, sleep disorders, respiratory failure
- MeSH terms
- Humans, Risk Factors, Time Factors, Treatment Failure, Pulmonary Disease, Chronic Obstructive, Noninvasive Ventilation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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