Developments in NIV: unusual applications and new modes

Endoscopy is frequently performed for diagnostic or therapeutic purposes, but is an invasive procedure with associated risks. For instance, in patients with hypoxemic or hypercapnic failure endoscopy impose a considerable risk of pulmonary complications and to a lesser degree cardiac complications. In high-risk patients, in whom noninvasive diagnostic tests are inconclusive, the clinician needs to decide either to proceed with empirical treatment or endotracheal intubation to allow endoscopy, for instance bronchoscopy or transesophageal echocardiography. It should be noted that both options are unattractive. For instance, in immune-compromised patients the differential diagnosis of pulmonary infiltrates may be extensive, making it difficult to decide for reasonable empirical treatment. On the other hand, endotracheal intubation results in high costs and imposes an considerable risk for the patient. In the last decade several studies have demonstrated the feasibility of noninvasive ventilation, as an alternative to endotracheal intubation to facilitate endoscopy in hypoxemic patients. Noninvasive ventilation may reduce the risks associated with endotracheal intubation and reduce healthcare costs, although the latter has never been formally evaluated.