What are the current guidelines for the use of non-invasive ventilation in patients with Type 2 respiratory failure?

Current guidelines recommend the use of non-invasive ventilation (NIV) in patients with Type 2 respiratory failure primarily in the context of conditions such as obesity hypoventilation syndrome (OHS) and motor neurone disease (MND).

For patients with OHS and severe obstructive sleep apnoea/hypopnoea syndrome (OSAHS) who do not have acute ventilatory failure, continuous positive airway pressure (CPAP) is the first-line treatment. NIV is offered as an alternative if symptoms do not improve, hypercapnia persists, or CPAP is poorly tolerated ².

In motor neurone disease, NIV should be considered after a comprehensive care plan is prepared by a multidisciplinary team, taking into account the patient's needs, lifestyle, tolerance, and safety. Initial acclimatisation to NIV is recommended during the day while awake, with regular treatment usually started at night and gradually increased as needed ¹.

Continuation of NIV depends on clinical reviews showing symptomatic or physiological improvements, including improvements in sleep-related symptoms, even in patients with severe bulbar or cognitive impairment ¹.

Support and training for patients and carers in the use of NIV, including emergency procedures and secretion management, are essential components of care ¹.