For certain acute respiratory failure (ARF) indications NIV can be used in non-acute settings to relieve pressure on the intensive care unit (ICU).
Although it is more commonly used in ICU and high acuity care areas, NIV also has the potential to be used outside the ICU setting. One reason to consider the use of NIV in sub-acute settings is that it could relieve some of the pressure on the scarce resource of ICU beds as seen in some countries as well as the high costs related to an ICU treatment.
Even though most evidence refers to use in acute care settings, the International Consensus supports the approach of performing NIV in lower acuity settings in hospitals. The International Consensus states: “[...] NPPV (unlike invasive mechanical ventilation) provides an opportunity for delivering ventilatory support elsewhere. NPPV need not be delivered continuously to be effective, can be reasonably initiated in the earliest stages of ARF, and administered by means of small, portable equipment. Potentially, NPPV can be administered in the emergency department, intermediate care unit, or general respiratory ward by physicians, nurses, or respiratory care practitioners. Potential benefits of use outside the ICU include early intervention to prevent further respiratory deterioration (7), access to respiratory support for patients who would not otherwise be admitted to the ICU (25-29), and the provision of support in a less intimidating setting.”¹
Deciding where to perform NIV should be less related to the actual care area, but rather to the care setting and staff knowledge.