No effects of EPHX1 polymorphisms on the level or change of FEV1 in the general population.

I thank B.C. Creagh-Brown and C. Shee for their complimentary comments. Furthermore, I completely agree with the principles described in their letter regarding the use of noninvasive ventilation (NIV) in selected patients who have chosen to forego, or are not offered, endotracheal intubation and invasive mechanical ventilation. In fact, I had the privilege of co-authoring a recent statement published by the Society of Critical Care Medicine [1] regarding the use of noninvasive ventilation for patients with ‘‘do not intubate’’ orders that I think is entirely consistent with the comments by B.C. CreaghBrown and C. Shee. In that statement, we argued that the use of NIV for patients with acute respiratory failure can be classified into three categories. 1) NIV as life support with no preset limitations on life-sustaining treatments. 2) NIV as life support when patients and families have decided to forego endotracheal intubation. 3) NIV as a ‘‘purely palliative’’ measure when patients and families have chosen to forego all life support and are receiving comfort measures only.