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Editorial
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Volume 350:2512-2515 June 10, 2004 Number 24
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Noninvasive Ventilation — Don't Push Too Hard
Jonathon Dean Truwit, M.D., and Gordon R. Bernard, M.D.

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Noninvasive mechanical ventilation has been used increasingly over the past decade in an effort to avoid endotracheal intubation and to accelerate the discontinuation of mechanical ventilation. Noninvasive ventilation as adjunctive therapy can be applied before intubation or after extubation (Figure 1). The literature indicates that in both settings, outcomes in patients with chronic obstructive pulmonary disease (COPD) or cardiogenic pulmonary edema are successful.1 Randomized, controlled trials also provide outcome data supporting the use of noninvasive ventilation to obviate the need for endotracheal intubation in immunosuppressed patients who have bilateral infiltrates and patients who are recovering from lung resection.1

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From the Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville (J.D.T.); and the Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University, Nashville (G.R.B.).


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