Mechanical ventilation (including non‑invasive ventilation) - ED revision
This section summarises practical principles, indications and initial management of mechanical ventilation in the emergency department, emphasising non‑invasive ventilation (NIV - CPAP and BiPAP), initial invasive ventilation targets and safe escalation/monitoring aligned with UK guidance (NICE, Resuscitation Council UK, RCEM).
Overview and classification
Mechanical ventilation provides artificial support for gas exchange when spontaneous breathing is inadequate. Two broad types:
- Non‑invasive ventilation (NIV): delivery of positive pressure via mask or helmet without tracheal instrumentation. Common ED modes are CPAP and BiPAP (NIPPV).
- Invasive ventilation: delivery of positive pressure via endotracheal tube or tracheostomy; usually continued and adjusted by ICU after ED stabilisation.
NIV avoids many risks of intubation and is often better tolerated, but must be delivered in an appropriate environment by trained staff with continuous monitoring and clear escalation pathways (NICE QS10). NIV is aerosol‑generating - follow local infection prevention guidance and appropriate PPE (RCEM).
Indications - when to consider ventilatory support in the ED
Indications overlap for NIV and invasive ventilation. Common reasons to start ventilatory support include:
- Acute hypercapnic (type 2) respiratory failure - for example, COPD exacerbation with acidosis.
- Acute hypoxaemic (type 1) respiratory failure - for example, pulmonary oedema or pneumonia (NIV usefulness varies with aetiology).
- Cardiogenic pulmonary oedema with severe dyspnoea.