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Management of acute ventilatory failure

Aintree Chest Centre, University Hospital Aintree, Liverpool, UK

Correspondence to:
Correspondence to:
Dr B Chakrabarti
Aintree Chest Centre, University Hospital Aintree, Liverpool, UK; biz{at}doctors.org.uk

Acute ventilatory failure is a challenging yet increasingly common medical emergency reflecting the growing burden of respiratory disease. It is not a diagnosis in itself but the end result of a diversity of disease processes culminating in arterial hypoxaemia and hypercapnia. This review focuses on key management issues including giving appropriate oxygen therapy, treatment of the underlying aetiology as well as any precipitant factors and provision of assisted ventilation if required. Ventilatory assistance can be provided both invasively and non-invasively and the indications for either or both forms of assisted ventilation are discussed. Further emphasis is needed regarding advanced directives of care and clinicians should be aware of ethical issues regarding assisted ventilation.

Abbreviations: AVF, acute ventilatory failure; COPD, chronic obstructive pulmonary disease; IPPV, invasive positive pressure ventilation; NIV, non-invasive ventilation; COAP, continuous positive airway pressure; NIPPV, non-invasive positive pressure ventilation; IPAP, inspiratory positive airways pressure; EPAP, expiratory positive airways pressure

Keywords: COPD; ventilatory failure; invasive ventilation; non-invasive ventilation; oxygen therapy