Indications and contraindications for NIV

Noninvasive ventilation (NIV) is commonly ordered, and in many cases allows an opportunity for a patient to recover in lieu of intubation and mechanical ventilation. 

According to the National Institute of Health, the following are the indications:

• Acute respiratory failure 
• Acute or chronic respiratory insufficiency 
• Documented sleep apnea

However nice NIV is, there are times when it is contraindicated.  It is up to the respiratory therapists to remind the attending physicians of these contraindications when they arise.  

Contraindications for NIV are

• Absence of a drive to breathe
• Inability to maintain a patent airway
• Inability to adequately clear secretions 
• Acute sinusitis or otitis media 
• Risk for aspiration of gastric contents 
• Hypotension (NIV may decrease cardiac output, decrease venous return)
• Pre-existing pneumothroax or pneumomediastinum 
• Epistaxis 
• Recent facial, oral or skull surgery or trauma 
• History of allergy or sensitivity to mask materials where the risk from allergic reaction outweighs the benefit of ventilatory assistance