Indications for non-invasive ventilation by aetiology of respiratory failure, level and strength of evidence and implications for domiciliary non-invasive ventilation
| Condition | Acute indication | Level and strength of evidence | Implications for domiciliary NIV |
|---|---|---|---|
| AECOPD | pH <7.35 and PaCO2 >6 kPa | Strong recommendation with high certainty7Grade A6 | Consider domiciliary NIV if PaCO2 >7 kPa at least 2 weeks after first episode of AHRF requiring NIV |
| CPO | Acute respiratory failure (PaO2 <8 kPa and/or PaCO2 >6 kPa | Strong recommendation with moderate certainty7 | Domiciliary NIV not indicated |
| OHS | pH <7.35 and PaCO2 >6 kPaIn some cases PaCO2 >6 kPa without acidosis | Grade B6 | Domiciliary NIV may be indicated. CPAP should be usual first choice of positive pressure support unless PaCO2 ≥8 kPa. Chronic respiratory failure may resolve with treatment of fluid overload |
| NMD and CWD | PaCO2 >6 kPaNormal PaCO2 with reduced vital capacity and tachypnoea | Grade D6 | Domiciliary NIV almost always indicated following an episode of hypercapnic respiratory failure |
| Asthma | Not indicated except in small subset behaving like COPD | Grades C and D6 | Usually not indicated but see COPD |
| Bronchiectasis | pH <7.35 and PaCO2 >6 kPa | Grade B6 | See COPD |
| Pneumonia | NIV not indicated (except in ICU) | Given uncertainty of evidence, no recommendation made7 | |
| Pneumonia complicating AECOPD | See COPD |
AECOPD = acute exacerbation of chronic obstructive pulmonary disease; AHRF = acute hypercapnic respiratory failure; CPAP = continuous positive airways pressure; CPO = cardiogenic pulmonary oedema; CWD = chest wall deformity; ICU = intensive care unit; NIV = non-invasive ventilation; NMD = neuromuscular disease; OHS = obesity hypoventilation syndrome.