What are the indications for initiating non-invasive ventilation (NIV) in patients with acute respiratory failure?

Indications for initiating non-invasive ventilation (NIV) in patients with acute respiratory failure include:

• Presence of hypercapnic respiratory failure, particularly in exacerbations of chronic obstructive pulmonary disease (COPD), where NIV can improve gas exchange and reduce the need for invasive ventilation.
• Patients who are slow to wean from invasive ventilation may be considered for NIV to support respiratory function.
• Symptoms and signs of respiratory impairment such as breathlessness, increased respiratory rate, use of accessory muscles, disturbed sleep, and morning headaches may indicate the need for NIV, especially when accompanied by physiological evidence of respiratory failure.
• Physiological criteria including hypercapnia (elevated arterial carbon dioxide levels) and acidosis are key indicators for starting NIV.

Initiation should be part of a comprehensive care plan involving multidisciplinary assessment, considering the patient's tolerance, safety, and support needs.

Regular monitoring and clinical review are essential to assess the effectiveness and continuation of NIV.

This approach aligns with UK guidelines on respiratory failure management and motor neurone disease care.

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