Liberation from Non-Invasive Ventilation in Complex Intensive Care Unit Patients

The evolution of non-invasive mechanical ventilation (NIV) from the iron lung of the 1950s to the use of sophisticated ventilators with mask apparatus has allowed for the optimal management of a wide range of respiratory disorders. NIV is now a mainstay in the management of acute, chronic and acute-on-chronic hypoxemic and hypercapnic respiratory failure from diverse etiologies. While NIV offers an effective approach to avoid invasive mechanical ventilation with its inherent risks of lung injury and sedation-related harms, it is a complex modality that requires a nuanced approach to management As the use of NIV has become ubiquitous, complex challenges are faced in the initiation, management and discontinuation of the treatment. We review complex clinical scenarios that present during liberation from non-invasive mechanical ventilation and an approach to successful weaning and liberation in these patient populations.