Noninvasive ventilation in adults with acute respiratory distress: a primer for the clinician.

Noninvasive ventilation (NIV) has become an integral part of critical care management. Despite > 2 decades of experience, it is relatively underused, with general utilization reported as a little over 10% in a recent international survey. Lack of training, knowledge, equipment, and experience with NIV may account for its slow adoption. Patient selection, staff training and experience, and prompt recognition of ineffective NIV are important components to successful application of NIV. Noninvasive ventilation does have a learning curve that may be steep for some institutions but must be mastered if the procedure is to become a successful institutional component of care. Patients with acute respiratory failure due to chronic obstructive pulmonary disease or congestive heart failure are ideal candidates for NIV, and optimal efficacy in associated conditions is often linked to these 2 conditions. Technical issues and written guidelines are addressed, including details of an adequate trial of therapy as well as criteria for intubation. Attention to these elements should increase the success rate of NIV, which in turn should increase its general use.