The Canadian Critical Care Trials Group/Canadian Critical Care Society Noninvasive Ventilation Guidelines Group has created new clinical guidelines for use of noninvasive ventilation in critical care settings. The new guidelines appear in the Canadian Medical Association Journal (CMAJ).

The guidelines address the use of noninvasive ventilation in the postoperative setting, in immunocompromised patients, in patients being weaned from conventional mechanical ventilation, and in patients at high risk of respiratory failure after removal of a breathing tube.

The guidelines recommend that noninvasive positive pressure ventilation should be the first choice in patients with chronic obstructive pulmonary disease (COPD) or cardiogenic pulmonary edema. It also can be used postoperatively or in people with compromised immune systems.

“Implementation of these guidelines may require clinician education, additional health care personnel, organizational change or additional resources (equipment or beds with cardiopulmonary monitoring) to ensure safe and appropriate application of noninvasive positive-pressure ventilation and continuous positive airway pressure,” writes Sean Keenan, MD, one of the study’s authors from the Royal Columbian Hospital, New Westminster, British Columbia, Canada.

“Strategies for the implementation of these guidelines should be developed for each relevant clinician group (physicians in different clinical areas and with different levels of training and expertise, respiratory therapists, and nurses),” he adds.

In a related commentary also appearing in the CMAJ, Andrew Bersten, MD, from Flinders Medical Centre in Adelaide, Australia, writes, “Many factors appear to influence the effective implementation of noninvasive ventilation. These factors include an experienced team of health care staff able to provide 24-hour service and detailed attention to mask interface and leaks, choice of equipment, ventilator settings, inspired oxygen levels, glottic function, and clearance of secretions.”

“For these guidelines to change clinical practice, they have to be supported by appropriate education, implementation and review. Helping clinicians know when and when not to use noninvasive ventilation is perhaps the most important role for these guidelines,” he concludes.

Source: Canadian Medical Association Journal