Review

Review of the role of non-invasive ventilation in the emergency department

Anthony M Cross

Emergency Department, Royal Melbourne Hospital, c/o Post Office, Parkville, Victoria 3050, Australia

Correspondence to:
Correspondence to: Dr Cross, Emergency Registrar

Accepted September 28, 1999

Introduction

One of the first descriptions of a "pulmonary plus pressure machine" in 1936 describes varying success in the treatment of cardiac asthma and bronchial asthma.¹ The author describes how an Electrolux or Hoover vacuum cleaner can be used to supply air at positive pressure and wisely cautions that "the machine should be run for some minutes first of all to get rid of the dust".

The aim of this article is to review the effects of non-invasive ventilation in acute respiratory failure, the evidence for its use in an emergency setting, and make some recommendations concerning its optimal use.

Pathophysiological effects of non-invasive ventilation

Extrinsically applied positive end expiratory pressure (ePEEP) increases alveolar size and recruitment.^{2, 3} This expands the area available for gas exchange, reduces intrapulmonary shunt, improves lung compliance, and decreases the work of breathing.^3–6 It acts to negate the effects of intrinsic PEEP (iPEEP), which is the cause of dynamic airway compression and . . . [Full text of this article]

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