Role of invasive and non-invasive ventilation in the treatment of acute respiratory failure [Indicazioni e tecniche di ventilazione invasiva e non invasiva nel trattamento dell'insufficienza respiratoria acuta]

Mechanical ventilation is the most common invasive treatment for acute respiratory failure in intensive care units. According to non-intensivist clinicians, ventilation could be considered as a therapy for blood gas exchange, even though positive pressure ventilation can be extremely dangerous for injured lung tissue. Despite constant advances in ventilation software and modalities, aimed at optimizing patient/ventilator adjustment, the scientific community has addressed major attention in new protective strategies to ventilate the lung, trying to prevent and reduce life-threatening iatrogenic injuries that may derive from inappropriate use of mechanical ventilation. In this review we describe the main ventilation techniques as well as new emerging methodologies. The physiological bases on which the acute respiratory distress syndrome network has significantly changed the strategy for ventilation in patients with acute respiratory distress syndrome are also discussed. Non-invasive ventilation, including both continuous positive airway pressure and pressure support ventilation, is considered the gold standard for chronic obstructive pulmonary disease exacerbations. There is an increasing interest in the clinical use of non-invasive ventilation outside intensive care units. Although many studies have analyzed risks and benefits of non-invasive ventilation in the intensive care setting, feasibility and organization processes to perform this technique in the non-intensive wards, by preserving efficacy and safety, need to be debated.