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We agree with the letter from Scala and Esquinas [1] in response to the article by Schortgen and colleagues [2], who emphasised the use of non-invasive ventilation in the ICU as the best ventilatory treatment for ‘do not intubate’ octogenarian patients. Scala and Esquinas argued that ICU beds are scarce and that the ICU environ ment alters contact between the patient and family. We do not, however, entirely accept the views of Schortgen and colleagues. Use of the non-invasive ventilation mask for palliative care patients with acute respiratory distress prevents the patient from eating and talking, and the patient’s experience can be that of being smothered. When the major indication is hypoxemia, a trea tment option is the administration of high-fl ow oxygen using up to 60 l/minute heated and humidifi ed oxygen through a nasal cannula [3] Th e mouth is thus freed and the patient is able to eat and talk with his family. Th e cost to effi ciency ratio is favourable because the Optifl ow® oxygenation system (Fischer and Paykel™, Auckland, New Zealand) costs €4,000 versus €15,600 for the V60® ventilation system (Philips™, Amsterdam, Th e Netherlands). Non-invasive ventilation appears preferable in chronic obstructive pulmonary disease patients with hypercapnia. We tested high-fl ow oxygen administration in 10 ‘do not intubate’ patients receiving palliative cancer care in whom a high oxygen concentration mask failed to relieve dyspnoea (abstract accepted for the Societe Francaise

Is non-invasive ventilation the best ventilatory support for 'do not intubate' patients?