The role of non-invasive ventilation

In the last few months, non-invasive respiratory support devices have been widely used, both inside and outside Intensive Care Units, in the treatment of hypoxemia that characterizes COVID-19 pneumonia and ARDS. In this scenario, also due to different regional epidemiological and clinical characteristics of the pandemic, the role of non-invasive positive pressure ventilation (NIPPV) is still currently debated. NIPPV has so far been applied heterogeneously with a predominantly empirical approach, its use in respiratory SARS-CoV-2 pandemic is reported in the literature in quantitatively or qualitatively poor studies. In the current state of knowledge, in continuous evolution, the effectiveness of NIPPV is therefore still too limited to allow any type of widespread recommendation and indeed involves serious caution, thus representing a very high risk of failure, even if in expert hands and in a semi-intensive setting. In this article we present and discuss, focusing on technical and non-technical features, a narrative review of the various available studies and experiences published in the literature, on NIPPV per se and in COVID-19 acute respiratory failure, and other shared considerations derived and supported by the authors’ direct personal experiences in the field matured in these dramatic months: all this in order to provide Emergency Physicians with a snapshot of the role, lights and shadows of NIPPV in COVID-19, from which to orient themselves in the world of daily clinical practice.