Ventilation non-invasive : un bénéfice dépendant de l'indication

Noninvasive ventilation (NIV) has became a major treatment of acute respiratory failure (ARF) and the use of NIV has dramatically increased among intensive care units. Nevertheless, various arguments suggest that the benefit of NIV depends on the cause of the underlying ARF. In acute on chronic respiratory failure and in cardiogenic pulmonay edema, data of the literature suggest a strong benefit of NIV on the risk of endotracheal intubation and mortality. In hypoxemic respiratory failure, the benefit of NIV is less obvious and seems to be restricted to very selected population of patients. Moreover, studies devoted to the benefit of NIV in hypoxemic respiratory failure have included many different causes of ARF that should not be compared to each other. Additionally, surveys and case-control studies, which are close to the daily medical practice, suggest that the benefit of NIV in hypoxemic respiratory failure is not as marked as in other causes of ARF. Future studies should aim at evaluating the benefit of NIV in more homogeneous populations of hypoxemic ARF patients. They should also try to define criteria that might allow an early identification of patients who will fail NIV.