Noninvasive Ventilation

Mechanical ventilation encompasses all procedures that use a mechanical device to assist or replace a patient’s respiratory function. If the ventilatory support does not require inserting an endotracheal tube (by oroor nasotracheal intubation or tracheostomy), it is called noninvasive ventilation (NIV).1,2 The early development of this therapeutic modality focused on patients with neuromuscular diseases, sequelae of tuberculosis, thoracic cage deformities, and hypoventilation-obesity syndrome.3 Negative pressure techniques were the most utilized during epidemics of poliomyelitis in the 1950s but were used less often after the development of mechanical ventilation through an endotracheal tube.4 At the beginning of the 1980s, when the efficacy of continuous positive airway pressure (CPAP) applied through a nasal mask was described for patients with obstructive sleep apnea syndrome,5 the number of patients receiving NIV was not great. However, the demonstrated ability of NIV to give effective, comfortable, and well-tolerated mechanical ventilation through a nasal mask6 encouraged exponential growth in the number of patients using that modality for long periods at home in Spain. Likewise, the application of positive pressure NIV devices in most respiratory medicine wards in Spain also increased.7-20 Negative pressure techniques were cast aside almost entirely and their use today is exceptional.21 The 1990s can be considered the decade of NIV and home ventilation thanks to the important invention of the nasal mask.