Noninvasive ventilation for respiratory failure: When does it work and when it does not?

Noninvasive positive pressure ventilation (NIV) is a positive pressure ventilation method employed across various disease processes, utilizing noninvasive interfaces such as helmets and facemasks rather than invasive methods such as endotracheal intubation. The benefits of NIV are significant in both the acute care setting, such as improving work of breathing and avoiding the need for endotracheal intubation, as well as in the chronic care setting, improving quality of life and mortality. While new guidelines broaden the application of NIV across various disease areas and introduce emerging modalities, uncertainty persists regarding the appropriate timing and circumstances for NIV utilization. We present a detailed review of the literature with up-to-date studies assessing the indications and limitations of NIV in a variety of conditions associated with acute and chronic respiratory failure. The review also summarizes the current guidelines on the use of NIV in the acute care setting. Although primarily targeted towards the acute indications of NIV, we believe this review will aid in better understanding and managing noninvasive ventilation for clinicians across both the inpatient and outpatient settings.