November 20, 1998

Traditionally, when patients suffer from acute respiratory failure, they have to be intubated, which means that a nine-inch tube is inserted into their trachea or windpipe, allowing the use of a mechanical ventilator to aid breathing. This method can save lives, but it is not without risks.

Through the efforts of the Pulmonary Medicine OI Team, MGH respiratory therapists have initiated a pathway for certain patients that uses a noninvasive method of ventilation. Using a face mask connected to a ventilator, patients are assisted in breathing. By closely monitoring the ventilator and encouraging patients to regulate their breathing, respiratory therapists help patients achieve improved respiratory function without invasive intubation.

"This method does require more time and effort from the respiratory therapists and the nursing staff, but the benefit for these patients is well worth it," says Dean Hess, PhD, RRT, assistant director of Respiratory Care Services. "Data shows that the need for intubation has decreased significantly, risk of infection has been controlled better, length of stay has been shortened and mortality rates have lowered using this method."

Noninvasive ventilation for acute respiratory failure is used primarily with patients who need short-term breathing assistance – patients with chronic pulmonary disease or congestive heart failure are likely candidates.

According to Kevin Strong, RRT, noninvasive ventilation also allows patients to talk, drink fluids and eat solid food while taking breaks from using the ventilator, all of which cannot be done if a patient is intubated.

Fred Romain, CRTT, middle, demonstrates the noninvasive pathway method on "patient" Kimberly Brown-Tyndall, RTT, while Nicola Ryding, RN, of the CCU looks on.