British Thoracic Society guidelines on non-invasive ventilation ▸

This is the latest publication from the British Thoracic Society outlining standards for the use of all forms of non-invasive ventilation (NIV) and continuous positive airways pressure (CPAP) for patients in acute respiratory failure. It is a robust and comprehensive document that reviews the available literature to provide evidence based standards of care. It sets minimum standards for the provision of an acute NIV service and provides guidance on how this may be achieved. The authors examine which patients may benefit from NIV or CPAP and give a list of indications and contraindications. They describe the optimum application of different modes of ventilation, define minimal monitoring standards, and address issues of treatment failure. There is discussion on areas that may benefit from further research and facilitation of data collection for audit.

The methodology was uncomplicated: a standard literature search for a review article. All recommendations have been given a grade A-D according to the level of evidence upon which they are based. The article begins with a history of the use of NIV, but leads on quickly to a summary of evidence based recommendations. There is a full review of the different modes of NIV available and an explanation of the different patient-machine interfaces available. The use of NIV and/or CPAP is considered in a wide range of conditions (ranging from COPD and pulmonary oedema to chest trauma and adult respiratory distress syndrome). Indications are clearly laid out, making this document not only an easily accessible practical guide, but also an authoritative text on the subject.

Considering that acute respiratory failure is a common cause for presentation to emergency departments, it is disappointing that this detailed document completely fails to mention the role of the emergency physician in initiating NIV. …