Non-invasive ventilation — the indications and the contraindications

The indications — confirm the indication list against local respiratory teaching; held scope: both CPAP and pressure-support NIV are effective in acute cardiogenic pulmonary oedema, and NPPV is first-line adjunct therapy for COPD-exacerbation respiratory failure.^[1][2]

The contraindications — inability to protect the airway, reduced consciousness or agitation, facial trauma or deformity, vomiting or obstruction or recent upper-GI surgery, undrained pneumothorax, copious secretions, and respiratory arrest.^[1]

^[3]The intubation over the NIV — a contraindication above, NIV failure (worsening acidosis, refractory hypoxia, exhaustion, altered consciousness), or severe respiratory arrest; CPAP by face mask reduced intubation need in severe cardiogenic oedema in the held RCT.^[3]

The principles: CPAP for type 1/oedema and BiPAP/NPPV for COPD/type 2 per local protocol — held COPD review: less intubation (RR 0.41), less treatment failure (RR 0.48), faster pH/PaCO2/rate improvement, fewer complications and shorter stay (WMD −3.24 days).^[2]