What are the key contraindications for the use of non-invasive ventilation in a primary care setting?

Key contraindications for the use of non-invasive ventilation (NIV) in a primary care setting include:

• Severe bulbar impairment or inability to manage airway secretions effectively, as this may increase the risk of aspiration and NIV failure.
• Severe cognitive impairment or dementia that impairs the person's capacity to understand, consent to, or cooperate with NIV treatment.
• Inability to tolerate the NIV interface or treatment, including poor mask fit or discomfort.
• Unstable medical conditions requiring invasive ventilation or intensive care, such as severe respiratory failure needing intubation.
• Lack of adequate support systems, including absence of trained carers or inability to access emergency clinical and technical support.
• Situations where NIV is unlikely to provide symptomatic or physiological improvement, for example, advanced disease stages without expected benefit.

In primary care, these contraindications necessitate careful assessment and often referral to specialist respiratory or multidisciplinary teams before initiating NIV.

References: NICE NG42,NICE NG115