Alternatives to Intermittent Positive Pressure Ventilation (IPPV)

It should be the aim of clinicians caring for patients with acute respiratory failure to produce the best outcome with the least complications and distress to the patient. Most patients with acute respiratory failure can contribute significantly to their own respiratory homeostasis with carefully applied airway pressure therapy, with the likelihood of reduced barotrauma and improved cardiovascular function. At present, the technique of CPAP + IM V is the method most suited to the above goals and allows independent treatment of the two forms of respiratory failure - hypoxaemia and hypoventilation. It offers flexibility in management of a wide range of conditions. Severe ARDS can be managed using high levels of CPAP, often with little or no mechanical ventilation, and invasive haemodynamic monitoring is frequently unnecessary. CPAP delivered by nasal prongs in adults is a useful new technique.