<unk>  for acute respiratory failure is used particularly for severe exacerbations of chronic obstructive pulmonary disease (COPD) but also for acute decompensated heart failure and other acute conditions.<unk>  can be used acutely and long-term. In some people who have presented with acute respiratory failure, there is an ongoing need for long-term use of<unk>  at home.<unk>  has been suggested in the treatment for coronavirus disease 2019 (COVID-19) where shortages of<unk>  ventilation equipment and facilities may arise. The risk of poorly fitting masks emitting aerosols can require full protection gear for caregivers. COPD The most common indication for acute<unk>  is for acute exacerbation of chronic obstructive pulmonary disease. The decision to commence<unk> , usually in the emergency department, depends on the initial response to medication (bronchodilators given by nebulizer) and the results of arterial blood gas tests. If after medical therapy the lungs remain unable to clear carbon dioxide from the bloodstream (respiratory acidosis),<unk>  may be indicated. Many people with COPD have chronically elevated CO2 levels with metabolic compensation, but<unk>  is only indicated if the CO2 is acutely increased to the point that the acidity levels of the blood are increased (pH2 level is elevated even if it has not yet caused acidosis. In neuromuscular disease, a breathing measurement known as the vital capacity is used to determine a need for breathing support. Obesity hypoventilation syndrome (OHS) may cause acute hypercapnic respiratory failure. When this is the case, the criteria for commencing acute<unk>  are similar to those for COPD (decreased pH, elevated CO2), although there are some scenarios where<unk>  may be initiated in hospitalized people despite a normal pH; these include people with daytime somnolence, sleep-disordered breathing and/or evidence of right ventricle heart failure. In acute cardiogenic pulmonary oedema caused by decompensated heart failure, the quality of evidence is poor but studies have shown a reduced risk of death and a decreased need for tracheal intubation for both<unk>  and CPAP. Both CPAP and<unk>  may be used in the prehospital care setting. Acute severe asthma may cause AHRF, when it is labelled "near-fatal asthma". There is limited evidence on whether<unk>  is effective in this situation, which carries a high risk of requiring mechanical ventilation. Professional guidelines therefore do not give a clear recommendation, and it is suggested that<unk>  is only used in an intensive care unit setting where further deterioration can be managed immediately, or not at all. Some people with chronic asthma develop fixed airways disease that resembles COPD, and<unk>  may be used in that setting. Respiratory failure may develop after major surgery.<unk>  may be used in this setting during the recovery period. In those who have undergone mechanical ventilation on the intensive care unit and are considered at high risk of recurrence,<unk>  may be used to prevent this. However, if respiratory failure does develop, recommencement of mechanical ventilation is recommended over<unk>  to treat this. In those who were ventilated for hypercapnic respiratory failure,<unk>  may be used to facilitate the weaning process. Chronic/home use Chronic use of<unk>  ("home<unk> ") may be indicated for severe COPD. A review from 2021 demonstrated that the chronic use of<unk>  improves daytime hypercapnia, In addition, in stable chronic obstructive pulmonary disease, survival seems to be improved and there might be a short term benefit of health-related quality of life. Home<unk>  may also be indicated in people with neuromuscular disease and chest wall deformity. People with obesity hypoventilation syndrome often require<unk>  initially in their care, but many can be switched to CPAP. American Thoracic Society (ATS) clinical practice guidelines recommend that<unk>  is provided on discharge with a further sleep study assessment as an outpatient. With regards to initiation of positive pressure treatment, the ATS guidelines recommend that in people being investigated for possible obstructive sleep apnea (OSA, a related condition), measurement of arterial carbon dioxide (in high probability) or venous bicarbonate (in moderate probability) is performed to identify OHS and to determine an indication for treatment. In those with both severe OSA and OHS, initial treatment with CPAP is recommended although the quality of research supporting this over<unk>  is poor. In the 30% of people with OHS who do not also have severe OSA,<unk>  may be more effective but is also more cost- and resource-intensive. In those who have both OSA and OHS, poor response to CPAP despite good adherence may be an indication to switch to<unk> . People with motor neuron disease (MND) may require home<unk>  in the course of their illness. Guidelines in the United Kingdom stipulate that assessment of respiratory function is part of the multidisciplinary management of MND.
Non-invasive ventilation
Negative pressure ventilator
Mechanical ventilation
Artificial ventilation
Positive airway pressure
High-frequency ventilation
Bubble CPAP
Pressure support ventilation