When a patient requires mechanical assistance to breathe, the choices are invasive mechanical ventilation (use of an endotracheal tube or tracheostomy tube – also referred to as intubation) or noninvasive mechanical ventilation (NIV). Luckily for patients’ comfort, NIV has become a replacement for invasive ventilation in certain situations in both acute and chronic respiratory failure.
Far from the days of the Drinker-Shaw iron lung, developed in 1928, modes of NIV today deliver positive air pressure to the patient rather than the original negative-pressure method. In the 1980s, positive-pressure ventilation devices were developed for patients with neuromuscular respiratory failure and later used for obstructive sleep apnea patients. Such devices deliver positive air pressure through a mask on the face rather than a tube inserted into the trachea. The success of this treatment led to its adoption in other conditions, including decompensated COPD. Nowadays, noninvasive positive-pressure ventilation delivered via a mask has been widely adopted, being a first-line therapy in some medical centers.
A variety of interfaces have now been designed to connect the patient to the machine: mouth piece, nasal mask, face mask, or helmet mask. Numerous ventilator modes also have been developed including volume ventilation, pressure support, bilevel positive airway pressure (BiPAP), proportional-assist ventilation (PAV), and continuous positive airway pressure (CPAP).
The good news for COPD patients is that, in an exacerbation requiring hospitalization, if mechanically assisted breathing is required, often it can be delivered without invasive techniques, significantly improving the patients’ comfort and lessening the chance of damage to the lungs or trachea.
Note: The information for this article was sourced from Medscape.com.