Pol Arch Intern Med. 2017 Sep 29;127(9):614-620. doi: 10.20452/pamw.4088. Epub 2017 Aug 17.
Noninvasive ventilation (NIV) has a well-‑established role in the treatment of acute-‑on-‑chronic respiratory failure and cardiogenic pulmonary edema. Its role in acute hypoxemic respiratory failure has been increasingly investigated, but its impact on the management and outcome of the subset of patients with acute respiratory distress syndrome (ARDS) is still to be determined. ARDS could be a risk factor for NIV failure, and in these patients, delayed endotracheal intubation can lead to an increased mortality. On the other hand, in a subset of patients with ARDS, endotracheal intubation can be avoided when NIV is applied. This review summarizes the current practice of NIV use in patients with ARDS and underlines the importance of proper patient selection before an NIV trial as well as criteria that should be used to predict failure early enough. A brief overview of high-‑flow nasal cannula is also provided. The use of NIV in ARDS is still debated, and it is important to be aware of the potential limitations and pitfalls of this treatment, which, when properly applied, could reduce the incidence of endotracheal intubation.
无创通气（NIV）在治疗急性加重期慢性呼吸衰竭和心源性肺水肿方面具有明确的作用。其在急性低氧性呼吸衰竭中的作用已得到越来越多的研究，但它对急性呼吸窘迫综合征（ARDS）亚组患者的管理和结局的影响仍有待确定。ARDS 可能是 NIV 失败的一个危险因素，在这些患者中，延迟气管插管可导致死亡率增加。另一方面，在 ARDS 的亚组患者中，当应用 NIV 时可以避免气管插管。本综述总结了目前在 ARDS 患者中使用 NIV 的情况，并强调了在进行 NIV 试验前进行适当的患者选择以及尽早预测失败的标准的重要性。还简要概述了高流量鼻导管的应用。ARDS 中使用 NIV 仍存在争议，重要的是要意识到这种治疗的潜在局限性和陷阱，当正确应用时，它可以降低气管插管的发生率。
