Noninvasive ventilation in adults with acute respiratory distress: a primer for the clinician

High potential of technology to face new respiratory viruses: mechanical ventilation devices for effective healthcare to next pandemic emergencies

Some countries in the presence of unforeseen Coronavirus Disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have experienced lower total deaths, though higher numbers of COVID-19 related infections. Results here suggest that one of the explanations is the critical role of ventilator technology in clinical health environment to cope with the initial stage of COVID-19 pandemic crisis. Statistical evidence shows that a large number of ventilators or breathing devices in countries (26.76 units per 100,000 inhabitants) is associated with a fatality rate of 1.44% (December 2020), whereas a higher fatality rate given by 2.46% is in nations with lower numbers of ventilator devices (10.38 average units per 100,000 people). These findings suggest that a large number of medical ventilators in clinical setting has a high potential for more efficient healthcare and improves the effective preparedness of crisis management to cope with new respiratory pandemic diseases in society. Hence, a forward-thinking and technology-oriented strategy in healthcare sector, based on investments in high-tech ventilator devices and other new medical technologies, can help clinicians deliver effective care and reduce negative effects of present and future respiratory infectious diseases, in particular when new drugs and appropriate treatments are missing in clinical environment to face unknown respiratory viral agents .

Management of Respiratory Failure

The management of acute respiratory failure varies according to the etiology. A clear understanding of physiology of respiration and pathophysiological mechanisms of respiratory failure is mandatory for managing these patients. The extent of abnormality in arterial blood gas values is a result of the balance between the severity of disease and the degree of compensation by cardiopulmonary system. Normal blood gases do not mean that there is an absence of disease because the homeostatic system can compensate. However, an abnormal arterial blood gas value reflects uncompensated disease that might be life threatening.

A case-based approach to noninvasive positive pressure ventilation

Noninvasive positive pressure ventilation (NIPPV) has revolutionized the concept of mechanical ventilation with the major benefit of avoiding invasive mechanical ventilation in specific situations, thereby preventing associated complications. Noninvasive positive pressure ventilation has emerged as the first line of management of hypercapnic respiratory failure (due to chronic obstructive pulmonary disease and neuromuscular weakness) and cardiogenic pulmonary edema in addition to standard therapy in the acute setting. There is improvement in gas exchange, relief of respiratory muscle fatigue, and clinical outcome with reduced morbidity and mortality. Nevertheless, contraindications and failures need to be identified early, as delaying endotracheal intubation is associated with increased morbidity and mortality. Despite overwhelming evidence to support its use, NIPPV is underused. Residents and hospitalists need to identify NIPPV as a treatment option in acute respiratory failure.