Japanese Respiratory Society: Revised NPPV Guidelines

After publication of the Japanese edition of the Noninvasive Positive Pressure Ventilation (NPPV) Guidelines (second revised edition), the Japanese Respiratory Society has published an abridged English edition of the guidelines. The English edition – which is freely available online in the journal Respiratory Investigation – consists of clinical questions, answers, and recommendations for specific NPPV interventions. The publication is intended to obtain  opinions of specialists in the field outside of Japan.

See Also: Noninvasive Ventilation

Although seven years have passed since the publication of the first edition and NPPV is increasingly used in respiratory care, NPPV is still a relatively new treatment method. "Therefore, the main focus of the second edition of the Guidelines was to improve comprehension of the newest evidence regarding the effectiveness of NPPV therapy," according to the writing committee.

The guidelines are intended to be used by physicians and other medical team members, as these comprehensive medical teams typically provide respiratory care. In order to address recent changes in NPPV therapy, sections on NPPV systems, use of sedative agents, management during natural disasters, and infection control were added to the general overview, the authors point out.  

The guidelines apply to patients with acute or chronic respiratory failure who require NPPV therapy. In the document, patients with stable medical conditions (excluding sleep apnoea) whom the attending physicians considered to be suited for mechanical ventilation at home and who were eligible for NPPV therapy through their health insurances were set as the standard.

"As mechanical ventilation is often an essential element of patient support, medical accidents are more likely to occur in care that requires its use. Although it may be difficult, it is necessary to confirm the will of the patient regarding treatment containing respiratory management at the end stage of disease," the authors emphasise. Before initiating NPPV therapy, the patient and the patient’s family should be sufficiently informed about this treatment method, and the will of the patient and their family to conduct NPPV must be confirmed.

In the guidelines, implementation of NPPV in patients with acute or chronic respiratory failure is described in detail, in addition to the financial and side effects of NPPV therapy and their countermeasures.

It should be noted that levels of evidence and grades of recommendation provided in the guidelines are the current levels. The authors say the content of the guidelines may be revised based on the results of future studies.

Source: Respiratory Investigation
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