Non-invasive ventilation in acute respiratory failure

INTRODUCTION Nomenclature Non-invasive ventilation (NIV) refers to the provision of ventilatory support through the patient’s upper airway using a mask or similar device. This technique is distinguished from those which bypass the upper airway with a tracheal tube, laryngeal mask, or tracheostomy and are therefore considered invasive. In this document NIV refers to non-invasive positive pressure ventilation, and other less commonly used techniques such as external negative pressure or rocking beds will not be discussed. (NIPPV is an alternative abbreviation but it is more cumbersome and involves ambiguity as to whether “N” is for “non-invasive” or “nasal”.) Continuous positive airway pressure (CPAP) in this document refers to the non-invasive application of positive airway pressure, again using a face or nasal mask rather than in conjunction with invasive techniques. Although it might be open to debate as to whether the use of non-invasive CPAP in acute respiratory failure constitutes ventilatory support, it is included in this document because of the confusion which commonly arises between NIV and CPAP in clinical practice.