The concept of augmenting spontaneous breathing effort by a close fitting face mask has evolved from initial case reports, nearly two decades ago, to become part of mainstream acute clinical care. Indeed, it has become the preferred option to invasive ventilation in many cases of acute hypercapnic respiratory failure (AHRF). In the UK, service development has been driven largely by respiratory physicians and this has resulted in an unintended, and unhelpful, dichotomy of responsibility for patient care. NIV guidelines that have been published have, by being concerned with the practicalities of delivery of a new service, failed to promote appropriate integration between those providing the acute NIV service and intensivists, the gate keepers to the intensive care unit (ICU) and who manage the invasively ventilated patient.
The joint British Thoracic Society (BTS)...
