Quel ventilateur choisir pour la ventilation non invasive au cours de l'insuffisance respiratoire aiguë ?

Noninvasive ventilation (NIV) has became a standard of care in acute respiratory failure (ARF). It allows a decrease in the use of invasive mechanical ventilation and of its complications, as well as a reduction in mortality. However, NIV fails to avoid intubation in approximately 40% of patients due to various causes. The choice of ventilator, taking into consideration its mechanical characteristics, user-friendliness, and its ability to compensate for leaks, is an important determinant of the success of NIV. Three types of ventilator are available for NIV: domiciliary, ICU and intermediate. Technical aspects and performance between groups and inside each group vary widely, making the final choice difficult. There is to date no proof of one ventilator's superiority over another in patients with ARF. Based on the available evidence, one can recommend that for moderate ARF, NIV can be performed with domiciliary and intermediary ventilators. For more severe cases with a high inspiratory demand, more powerful ventilators of the ICU type are needed, which provide the additional benefit of an adjustable FiO2. Moreover, the final choice of ventilator will also be determined by each ICU's routine and budget.