[Noninvasive mechanical ventilation in the exacerbation of respiratory diseases]

Noninvasive ventilation (NIV) utilization has experienced an exponential growth in the last 25 years immediately after the introduction of the positive pressure and the nasal mask. Patients with acute, chronic and acute on chronic respiratory failure are candidates to be treated by this therapeutic modality. Its utilization inside the hospital is very heterogeneous being indicated for diverse patients by different levels of complexity and severity levels. We have scientific evidence of the maximum level for certain problems such as COPD exacerbations with respiratory acidosis, acute pulmonary edema, or patients with solid and hematologic transplantation, although its utilization has been generalized to many other clinical scenes using minor levels of evidence. NIV is also used successfully in patients of advanced age, patients with do not intubate orders or even patients with severe comorbidities. Finally, NIV could be used as a palliative tool. The continuous technological evolution and the need of formation of the professionals demands organizational changes in the hospitals and the necessity to define specific areas for most severe patients, such as respiratory intermediate care units.