Patient-ventilator Interaction during Noninvasive Ventilation

Abstract

Over the years, non-invasive ventilation (NIV) has evolved into becoming a standard of care in both hypercapnic and non-hypercapnic acute respiratory failure [1–3]. However, its success in avoiding intubation is largely determined by patient tolerance to the technique [4]. The optimal combination of the patient’s spontaneous breathing activity and the ventilator’s set parameters, known as ’patient-ventilator interaction’, depends on numerous factors, and can prove very difficult to achieve [5, 6]. If patient ventilator asynchrony is present, the work of breathing can increase [5, 6]. Further complicating the matter, leaks at the patient-mask interface during NIV can interfere with various aspects of ventilator function, thereby increasing the risk of patient-ventilator asynchrony [7–10]. As an illustration, a recent study documented that severe asynchrony was present in 43 % of patients undergoing NIV for acute respiratory failure [11]. Consequently, when applying NIV the clinician must pay close attention to both the proper setting of ventilator parameters and the avoidance of excessive leaks at the patient-mask interface.