Noninvasive positive pressure ventilation for acute respiratory distress syndrome

Invasive mechanical ventilation with positive pressure forms the mainstay of ventilatory support in acute respiratory syndrome (ARDS). Although NPPV is increasingly used in patients with ARDS, a metaanalysis has shown a success rate as low as 50%, which suggests a need for careful introduction of NPPV for the treatment of ARDS. NPPV often fails in ARDS patients with severe illness. In case the oxygenation index is not improved after 1 hour of NPPV, invasive mechanical ventilation should be initiated. In patients with severe pneumonia, NPPV is not routinely recommended. However, among patients with chronic obstructive pulmonary disease, NPPV is associated with a better outcome for acute respiratory failure caused by severe pneumonia.