History and epidemiology of noninvasive ventilation in the acute-care setting

Although noninvasive ventilation (NIV) was first used to treat patients with acute respiratory failure in the 1940s, the history of this mainstay of today's respiratory care armamentarium has mainly been written in the last 20 years. There is now a robust evidence base documenting the efficacy of NIV in exacerbations of chronic obstructive pulmonary disease, cardiogenic pulmonary edema, and acute respiratory failure in immunocompromised patients, and evidence in support of NIV in other settings, such as hypoxemic acute respiratory failure and the management of patients who decline endotracheal intubation, is accumulating rapidly. Efficacy as demonstrated in clinical trials does not necessarily translate to clinical effectiveness in practice, however, and important barriers need to be overcome if NIV is to realize for the average patient the potential it has shown in research studies. However, although the expansion of its use in everyday patient care has lagged behind the growth of its evidence base, an increasing number of studies document the steadily expanding use of NIV in the acute-care setting. This article reviews the history of NIV as applied in acutely ill patients and summarizes the studies of NIV outside the research setting during the last decade.