Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android



  1. Discuss patient selection for noninvasive ventilation (NIV).

  2. Compare interfaces for NIV.

  3. List advantages and disadvantages of various ventilator types for NIV.

  4. List the steps in the initiation of NIV.

One of the significant advances in respiratory critical care over the past 20 years has been the emergence of noninvasive ventilation (NIV). NIV is used increasingly in patients with acute respiratory failure. In appropriately selected patients, need for intubation is reduced with the use of NIV. Because an artificial airway increases the risk of nosocomial pneumonia, it is not surprising that use of NIV decreases the incidence of ventilator-associated pneumonia. In some clinical settings, such as chronic obstructive pulmonary disease (COPD) exacerbation or acute cardiogenic pulmonary edema, the use of NIV affords a survival benefit. This chapter covers clinical and technical issues related to use of NIV.

Patient Factors

Patient Selection

The strength of evidence for the use of NIV for various causes of acute respiratory failure is summarized in Table 11-1. High-level evidence supports the effectiveness of NIV for COPD exacerbation. Equally strong evidence supports the use of NIV for acute cardiogenic pulmonary edema. There is also evidence to support the use of NIV in patients with respiratory failure following solid organ transplantation and those who are immunosuppressed. Although some evidence supports the use of NIV for acute asthma, the evidence in this setting is weak. The use of NIV as an alternative to invasive ventilation in severely hypoxemic patients with acute respiratory distress syndrome is not recommended.

Table 11-1Strength of evidence supporting use of noninvasive ventilation for acute respiratory failure

NIV can be used to allow ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.