Adverse Events in Non-invasive Ventilation Approaches: Systematic Review

Abstract

Non-invasive ventilation (NIV) plays a critical role in the management of acute and chronic respiratory failure, offering benefits over invasive mechanical ventilation. However, its use is associated with various adverse events that may impact clinical outcomes. This systematic review aimed to evaluate the types, frequencies, and clinical consequences of complications related to NIV. A systematic search of PubMed, EMBASE, and Cochrane Library databases was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 'PRISMA' guidelines, covering studies published between 2000 and February 2023. Eligible studies included randomized controlled trials, observational cohorts, and systematic reviews reporting adverse events in adults receiving NIV for respiratory failure. Thirty-two studies involving approximately 6,000 patients were analyzed. NIV-related complications were frequently reported, including, physiological (e.g., hypercapnia 2-10%, hypoxemia 1-5%), mechanical (e.g., skin breakdown 5-15%, air leaks 5-25%), and patient-related events (e.g., discomfort 10-30%, anxiety 5-15%). Face masks were linked to higher rates of air leaks and intolerance, while helmet interfaces showed fewer complications. Helmet interfaces and newer ventilator technologies showed advantages in minimizing certain adverse events. Although NIV offers substantial benefits compared to invasive ventilation, its effectiveness can be compromised by preventable complications. Structured monitoring, early intervention, and a multidisciplinary care approach are essential for maximizing outcomes. Further research is needed to develop strategies that enhance patient comfort, minimize complications, and optimize NIV application across different clinical settings.