EMERGENCIES IN CRITICAL CARE: Edited by Wesley H. SelfNoninvasive ventilation as acute therapyThille, Arnaud W.a,b; Frat, Jean-Pierrea,bAuthor Information aCHU de Poitiers, Réanimation Médicale bINSERM CIC 1402 – ALIVE, Université de Poitiers, Faculté de Médecine et Pharmacie, Poitiers, France Correspondence to Jean-Pierre Frat, Réanimation Médicale, CHU de Poitiers, 2 rue la Milétrie, 86021 Poitiers, Cedex, France. Tel: +33 549444007; e-mail: [email protected] Current Opinion in Critical Care: December 2018 - Volume 24 - Issue 6 - p 519-524 doi: 10.1097/MCC.0000000000000554 Buy Metrics Abstract Purpose of review Noninvasive ventilation (NIV) is widely used in ICU patients to treat or to prevent acute respiratory failure. Whereas its physiological effects are clearly beneficial in hypercapnic patients, it could be deleterious in hypoxemic patients without hypercapnia. Recent findings NIV should be cautiously used in patients with de-novo respiratory failure, the vast majority of whom meet the criteria for acute respiratory distress syndrome. Spontaneous breathing with high tidal volumes may worsen lung injury in these patients, and recent findings suggest that NIV may increase the risk of mortality. Even though high-flow oxygen therapy is increasingly applied in this context, NIV remains recommended for management of immunocompromised patients with acute respiratory failure. NIV should be the first-line oxygenation strategy in patients with acute hypercapnic respiratory failure when pH is equal to or below 7.35. Prophylactic NIV prevents respiratory failure after extubation of patients at high risk of reintubation. Summary Most previous studies have compared NIV with standard oxygen, and recent recommendations have been established from these findings. Given the growing use of high-flow oxygen therapy, new studies are needed to compare NIV versus high-flow oxygen therapy so as to better define the appropriate indications for each treatment. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.