Table 1.

Recommendations for use of non-invasive ventilation to treat acute respiratory failure

Recommendations based on levels of evidence21 Level 1 evidence Systematic reviews (with homogeneity) of RCTs and individual RCTs (with narrow CIs) Evidence of use (favourable) •COPD exacerbations •Facilitation of weaning/extubation in patients with COPD •Cardiogenic pulmonary oedema •Immunosuppressed patients Evidence of use (caution) •None Level 2 Systematic reviews (with homogeneity) of cohort studies—individual cohort studies (including low-quality RCTs; eg, <80% follow-up) Evidence of use (favourable) •Do-not-intubate status •End-stage patients as palliative measure •Extubation failure (COPD or congestive heart failure) (prevention) •Community-acquired pneumonia in COPD •Postoperative respiratory failure (prevention and treatment) •Prevention of acute respiratory failure in asthma Evidence of use (caution) •Severe community-acquired pneumonia •Extubation failure (prevention) Level 3 Systematic reviews (with homogeneity) of case–control studies, individual case–control study Evidence of use (favourable) •Neuromuscular disease/kyphoscoliosis •Upper airway obstruction (partial) •Thoracic trauma •Treatment of acute respiratory failure in asthma Evidence of use (caution) •Severe acute respiratory syndrome Level 4 Case series (and poor-quality cohort and case–control studies) Evidence of use (favourable) •Very old age, older than age 75 years •Cystic fibrosis •Obesity hypoventilation Evidence of use (caution) •Idiopathic pulmonary fibrosis

CI, confidence interval; COPD, chronic obstructive pulmonary disease; NIV, non-invasive ventilation; RCTs, randomized controlled trials. (Reprinted from Lancet, vol. 374; 250–259. Nava S, Hill N, Non-invasive ventilation in acute respiratory failure. With permission from Elsevier).