ABSTRACT
The use of non-invasive ventilation (NIV) to treat both acute respiratory failure (ARF) and chronic respiratory failure (CRF) has tremendously expanded in the last two decades in terms of the spectrum of diseases that can be successfully managed,1-4 the locations of application and use5-8 and achievable goals.9-11 Despite the huge amount of literature and data dealing with physiological, clinical and technological features of NIV, a ‘clear recipe’ that a team should use in the clinical practice to start NIV is lacking. Results of randomized controlled trials (RCTs) obtained by very selected centres with high experience in NIV cannot be translated into a ‘real-world scenario’ where skills, standardization and expertise may not be always adequate.12-16 This is not surprisingly since NIV, like other treatments in medicine, has to be considered as a rational ‘art’ and not just as an application of ‘science’; in other words, NIV requires the ability of clinicians to
choose case by case the best ‘ingredients’ (i.e. patient selection, interface, ventilator, interface, methodology, etc.) in order to calibrate specific protocols for their own institution.17,18
This chapter intends to highlight the ‘key ingredients’ that would be of practical help in the challenging issue of ‘how to start NIV’ both in ARF and CRF. We do not discuss negative pressure ventilation, another technique of NIV, as it is covered in another chapter.
