ABSTRACT
Indications for use of non-invasive ventilation (NIV) are increasing, based on improved outcomes (compared with invasive ventilation) and reduced risks (such as fewer nosocomial infections). At the same time, NIV has made it possible to support or palliate patients who have elected to forego more invasive life-sustaining measures, such as endotracheal intubation. Despite evidence that NIV can prevent intubations or improve mortality, especially in COPD exacerbations, cardiogenic pulmonary oedema and immunocompromised patients with hypoxaemic respiratory failure, underutilization is widespread. Some hospitals miss opportunities to provide NIV because they lack expertise, fail to invest the necessary resources, have no champions, or resist change. Although NIV is becoming more common, it could be used more extensively. Therefore, we emphasize a multidisciplinary team approach to building the competencies necessary for an institution to succeed at providing NIV safely to those most likely to benefit.
