Noninvasive ventilation for acute respiratory failure

Noninvasive ventilation refers to any form of ventilatory support applied w ithout the use of an endotracheal tube. It offers the potential to provide primary treatment for acute respiratory failure while avoiding complication s associated with mechanical ventilation with endotracheal intubation. Noni nvasive ventilation has been most commonly studied in hypercapnic respirato ry failure. A review of randomized, controlled studies shows mixed results and methodologic limitations affect the interpretation of current evidence. Patient selection is clearly the most important issue in considering nonin vasive ventilation for acute respiratory failure. Unfortunately, patients w ho benefit from noninvasive ventilation represent only a minority of the to tal group with any one disease, and thus it is difficult to make broad conc lusions concerning applicability of this treatment modality. Future studies are needed to focus on determining the specific patient populations who wi ll benefit the most, evaluating the optimal ventilatory mode and mask for p roviding noninvasive ventilation, and clarifying its impact on clinical out comes.