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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 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]
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“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]
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Metadata
- 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 (medical) › 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
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