NPPV in acute respiratory failure: is it time to reconsider where it may be applied?

The use of noninvasive positive-pressure ventilation (NPPV) as a means of ventilatory support has been around for as long as the profession of respiratory care. In fact, for a substantial part of my career, noninvasive positive-pressure treatments were the primary therapeutic activity provided by respiratory therapists. In the mid-1960s many of the first patients I mechanically ventilated were ventilated noninvasively. Of course, we did not have the equipment or the knowledge we have today, and the use of continuous NPPV as life support for patients with acute respiratory failure stopped with the introduction of volume ventilators that could provide assisted ventilation.