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Editor,—We read with interest the excellent review article by Anthony Cross1 on the subject of non-invasive ventilation (NIV) in the emergency department but would like to make the following comments.
There is little evidence to support the conclusion that NIV is “extremely useful in an emergency department setting in the first line treatment of acute respiratory distress”. As Cross points out, most of the trials in this area have been performed in an intensive care or high dependency setting where the patients were been selected by virtue that other treatments had failed. Many patients presenting to accident and emergency (A&E) with acute respiratory distress will get better after initiation of other treatments such as bronchodilators and controlled oxygen therapy (in the case of chronic obstructive airway disease (COAD)) or oxygen, …