Near-Fatal Asthma

By Mark D. Siegel, MD, FCCP

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Mechanical Ventilation

Noninvasive Positive Pressure Ventilation

Some patients with respiratory failure may benefit from a trial of noninvasive positive pressure ventilation (NIPPV). Potential advantages include comfort, decreased need for sedation and neuromuscular blockade, and a lower risk of nosocomial pneumonia.⁵ Disadvantages include lack of airway control and possible skin pressure ulceration. In one series, NIPPV was used in 17 patients for an average of 16 h.⁵⁷ NIPPV was generally well tolerated and only two patients required intubation. In a more recent report, NIPPV was used in 27 of 132 patients admitted to the medical ICU for status asthmaticus; 5 of the 7 subsequently required intubation.⁴ Randomized, controlled trials are needed to better define the role of NIPPV.

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