TY - JOUR T1 - British Thoracic Society/Intensive Care Society Guideline for the ventilatory management of acute hypercapnic respiratory failure in adults JF - BMJ Open Respiratory Research JO - BMJ Open Resp Res DO - 10.1136/bmjresp-2016-000133 VL - 3 IS - 1 SP - e000133 AU - Craig Davidson AU - Steve Banham AU - Mark Elliott AU - Daniel Kennedy AU - Colin Gelder AU - Alastair Glossop AU - Colin Church AU - Ben Creagh-Brown AU - James Dodd AU - Tim Felton AU - Bernard Foëx AU - Leigh Mansfield AU - Lynn McDonnell AU - Robert Parker AU - Caroline Patterson AU - Milind Sovani AU - Lynn Thomas Y1 - 2016/03/01 UR - http://bmjopenrespres.bmj.com/content/3/1/e000133.abstract N2 - The British Thoracic Society (BTS) published the guideline ‘The use of non-invasive ventilation in acute respiratory failure’ in 2002.1 This was in response to trials that had demonstrated that non-invasive ventilation (NIV) was an alternative to invasive mechanical ventilation (IMV) in life-threatening respiratory acidosis due to acute exacerbations of chronic obstructive pulmonary disease (AECOPD). It drew attention to evidence that, when NIV was used in the less severely unwell patient, it also limited progression to more severe respiratory failure.2 The trial also demonstrated the feasibility, of delivering NIV on general medical or admission wards that had enhanced support and when staff were provided with ongoing training.In subsequent years, NIV has been shown to deliver better rather than equivalent outcomes to invasive ventilation in AECOPD and better evidence has accumulated for the use of NIV in non-COPD disease in the intervening years. Repeated national audits have, however, raised concerns that expected patient benefit is not being delivered and have pointed to a number of process deficiencies.3–5 There is also the risk, in the absence of justifying trial evidence, that the preferred use of NIV in AECOPD might be extended to all hypercapnic patients, irrespective of circumstance or underlying disease process. That this is a real risk might be inferred from the BTS audits where the indication for NIV was not COPD in over 30% of cases.3 ,4NIV development in the UK has been largely outside the organisational ‘umbrella’ of critical care. This may have adversely affected resource allocation and contributed to a lack of integration in NIV and IMV patient pathways. Other unintended consequences might be a restriction on access to invasive ventilation and delay in the development of extended applications of NIV, such as accelerating extubation and its use in the management of … ER -