Noninvasive ventilation in acute care: controversies and emerging concepts

This conference brought together experts on noninvasive ventilation (NIV) to discuss and debate the advances in evidence and technology over the past decade. A major impetus for the conference was that many institutions have not systematically integrated NIV into their clinical practice, despite mounting, high-level evidence supporting its effectiveness. NIV clearly improves outcomes for patients with chronic obstructive pulmonary disease and acute cardiogenic pulmonary edema when instituted as a first-line therapy. Although the evidence is less persuasive, initial intervention with NIV also might benefit a carefully selected subset of patients with acute lung injury, as well as those with acute respiratory failure who are immunocompromised. The papers in this and last month's special issue of the Journal provide an informative guide for clinicians attempting to implement NIV in their institutions. This paper summarizes the major findings from each presentation and the discussions that followed.