Noninvasive mechanical ventilation with high pressure strategy remains a "double edged sword"?

Antonio M Esquinas,1 Gherardo Siscaro,2 Enrico M Clini21Intensive Care Unit, Hospital Morales Meseguer, Murcia, 2Department of Medical and Surgical Sciences, University of Modena, Pavullo-Modena, ItalyWe read with great interest the original work by Murphy et al analyzing the effects of two treatment strategies for delivery of noninvasive mechanical ventilation in hypercapnic patients with chronic obstructive pulmonary disease.1 High pressure and high intensity noninvasive mechanical ventilation were compared in a short-term crossover trial to assess whether high intensity noninvasive mechanical ventilation (inspiratory pressure > 25 cm H2O associated with a high backup ventilator rate) may improve adherence, physiological, and subjective outcomes when compared with delivery of high pressure noninvasive mechanical ventilation (without elevated backup respiratory rate). The authors concluded that both strategies are equivalent in all the recorded outcomes, showing thus that driving pressure, but not backup respiratory rate, is essential to gain physiological and clinical benefits in this population when in a chronic stable condition.View original paper by Murphy and colleagues.