Protocol for the use of Noninvasive Mechanical Ventilation in the Adult Unit Intensive Care Area

Abstract

Noninvasive mechanical ventilation (NIMV) is used in patients with acute respiratory failure to improve gas exchange and reduce the work of breathing, without the need for an artificial airway1. It is a modality of ventilatory assistance that provides two levels of pressure. It should be noted that the pressure increases during the inspiratory phase of breathing, increasing the tidal volume, thus improving gas exchange,  relieving the respiratory muscles and this returns to a high baseline on exhalation.
The pressure rise during the IPAP (inspiratory positive airway pressure) inspiratory phase is similar to pressure support ventilation of conventional ventilators. During expiration, the pressure setting in devices designed primarily for NIMV is called expiratory positive airway pressure (EPAP). It should be considered that EPAP is similar to PEEP on a conventional ventilator2.
Knowledge of its functionality allows determining in which patients the use of non-invasive ventilation is indicated and establishing an initial management strategy. It should be considered that, with greater severity of the respiratory pathology, non-invasive ventilation did not reduce the need for intubation or mor-
tality3,4 . These results were related to studies carried out in the context of the SARS COV 2 pandemic where it was found that non-invasive ventilation in patients with a certain degree of respiratory involvement reduced the use of invasive ventilation and mortality5-8.