Cited by 263Respiratory Support and MechanismsObstructive Sleep Apnea ResearchAirway Management and Intubation Techniques

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Timing of noninvasive ventilation failure: causes, risk factors, and potential remedies

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Ozyilmaz, Ezgi, Ugurlu, Aylin Ozsancak, Nava, Stefano·2014·BMC Pulmonary Medicine

DOI 10.1186/1471-2466-14-19PMC PMC3925956

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Abstract

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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Figure 1 Mean NIV failure rates based on timing according to the data of randomised controlled trials (6–12).CC BY · PubMed Central

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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
Publisher: Springer Science and Business Media LLC
Published: 2014-02-13
Volume: 14
Issue: 1
Pages: 19-19
ISSN: 1471-2466 (ISSN-L)
DOI: 10.1186/1471-2466-14-19
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: cc-by
www.springer.com/tdm (unspecified)
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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Timing of noninvasive ventilation failure: causes, risk factors, and potential remedies

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