Timing of non-invasive ventilation

Non-invasive ventilation (NIV) is a safe, versatile and effective technique that can avoid the side effects and complications associated with endotracheal intubation. The success of NIV relies on several factors including the type and severity of acute respiratory failure, underlying disease, location of treatment, and experience of the team. Timing is also an important factor. NIV is primarily used: to prevent the occurrence of impending (but not established) acute respiratory failure; at an early stage, when respiratory failure is already established, to avoid the need for endotracheal intubation; as an alternative to invasive ventilation at a more advanced stage of acute respiratory failure; if the patient has required intubation to prevent the development of respiratory failure once extubated; to treat established postextubation respiratory failure; and to facilitate the process of weaning from mechanical ventilation. The chapter analyses, compares and discusses the results of studies in which NIV was applied at various times during the evolution of acute respiratory failure.