Respiratory and sleep medicine
Non-invasive ventilation
How bilevel NIV and CPAP work, who benefits (COPD, obesity hypoventilation, motor neurone disease, cardiogenic oedema), setting up and titrating a mask, reading the 1-hour gas, troubleshooting leak and asynchrony, recognising failure, and starting home NIV.
Tier 1Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- NIV delivers positive pressure through a mask, without an endotracheal tube. It is ventilation (bilevel pressure support) or CPAP (a single pressure, which splints but doesn't ventilate).
- Its strongest evidence is in acute hypercapnic acidosis from COPD, where it roughly halves mortality and intubation. ATS 2026 makes a strong recommendation for it here.
- Other proven uses: cardiogenic pulmonary oedema, high-risk post-extubation support, and long-term home NIV in COPD with persistent hypercapnia, obesity hypoventilation and neuromuscular or chest wall disease.
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Sources
- BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adultsBritish Thoracic Society and Intensive Care Society (Thorax), 2016 (still the current BTS guideline, checked November 2026)
- Noninvasive respiratory support for adult patients with acute respiratory failure: an official American Thoracic Society clinical practice guideline (Goel NN et al. Am J Respir Crit Care Med 2026;212:2135-2158)American Thoracic Society, 2026
- Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure (Rochwerg B et al. Eur Respir J 2017;50:1602426)European Respiratory Society and American Thoracic Society, 2017
- Long-term noninvasive ventilation in chronic stable hypercapnic COPD: an official American Thoracic Society clinical practice guidelineAmerican Thoracic Society (Am J Respir Crit Care Med), 2020
- European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD (Ergan B et al. Eur Respir J 2019;54:1901003)European Respiratory Society, 2019
- Evaluation and management of obesity hypoventilation syndrome: an official American Thoracic Society clinical practice guidelineAmerican Thoracic Society (Am J Respir Crit Care Med), 2019
- The COPD-X Plan: Australian and New Zealand guidelines for the management of chronic obstructive pulmonary diseaseAU/NZLung Foundation Australia and Thoracic Society of Australia and New Zealand, V2.78, December 2025
- Thoracic Society of Australia and New Zealand position statement on acute oxygen use in adults ("Swimming between the flags")AU/NZThoracic Society of Australia and New Zealand (Respirology), 2022
- Effect of home noninvasive ventilation with oxygen therapy vs oxygen therapy alone on hospital readmission or death after an acute COPD exacerbation (HOT-HMV)JAMA (Murphy et al), 2017
- Long-term non-invasive ventilation versus CPAP in obesity hypoventilation syndrome with severe OSA (Pickwick study, Masa JF et al. Lancet 2019;393:1721-1732)The Lancet, 2019
- Effects of non-invasive ventilation on survival and quality of life in patients with amyotrophic lateral sclerosis (Bourke SC et al. Lancet Neurol 2006;5:140-147)Lancet Neurology, 2006
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy