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It is the mainstay of ventilatory support in patients with acute respiratory failure from diverse causes, with most of the evidence supporting its use in the acute setting for COPD exacerbations and cardiogenic pulmonary edema.It is also extensively used in chronic conditions including obstructive sleep apnea, sleep-disordered breathing associated with congestive heart failure, conditions associated with hypoventilation such as central sleep apnea, Bilevel positive airway pressure ventilation cycles between a higher inspiratory positive airway pressure (IPAP) and a lower expiratory positive airway pressure (EPAP).ASV is used in patients with Cheyne-Stokes respiration/central sleep apnea syndrome (CSR-CSA), in patients with congestive heart failure, and in patients with the complex sleep apnea syndrome.

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In these devices, a target tidal volume or alveolar ventilation is set, and the device adjusts the pressure support to reach that target.

The advantage of this mode of ventilatory support is to guarantee a delivered tidal volume despite variability in patient effort, airways resistance and lung or chest wall compliance.

The breathing is triggered by a spontaneous patient effort.

Additionally, in some patients, a set back up rate can be set such as in conditions associated with central apneas (with absence of spontaneous efforts), persistent hypercapnia (to augment minute ventilation), or neuromuscular diseases (when spontaneous breath could be so weak that they fail to trigger the device).

In this review, we summarize the different modalities of this assisted ventilation technique, review their indications and contraindications in specific conditions both in the acute hospital setting and in chronic conditions managed at home.

Back to Top The first step in understanding noninvasive mechanical ventilation is to understand the nomenclature.

Goal is to treat Cheyne-Stokes respiration/central sleep apnea.

The names of the modes may change between manufacturers, as well as the algorithms to titrate settings.

Noninvasive ventilation is the delivery of mechanical ventilation without the need for artificial airway through the larynx or trachea.

The traditional method to administer noninvasive ventilation was through devices that generated negative pressures (i.e., noninvasive negative pressure ventilation), such as the cuirass or the iron lung.

Whereas pressure-controlled devices are the most commonly used modalities for noninvasive support of ventilation in both acute and chronic setting, volume-controlled ventilators are also available, most often as adaptations of devices intended for use via tracheostomy.

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