Non-invasive ventilation for frail elderly patients with acute respiratoryfailure

We describe 3 elderly patients with acute respiratory failure who received respiratory assistance with nasal bi-level positive airway pressure (BiPAP) on the ward. In these patients with poor prognostic factors, non-invasive positive pressure ventilation was preferred as a reasonable alternative to invasive ventilation; indeed, their admission to the intensive care unit fo r mechanical support was considered inappropriate. Despite the small number of patients and limited experience with the technique, BiPAP is discussed here as a possible treatment for severe respiratory failure when endotrache al ventilation is controversial, especially in frail patients 80 years of a ge or older, because invasive ventilation is associated with high mortality and morbidity in these patients. Two questions nevertheless need further e valuation in this setting, and are also addressed. The first is technical: can transient non-invasive breathing assistance be delivered on the ward? T he second is ethical: is BiPAP a possible alternative when invasive ventila tion is considered inappropriate?