Noninvasive ventilation in palliative care and near the end of life]

The occurrence of life threatening severe respiratory failure in patients with an incurable illness may be an indication for the use of noninvasive ventilation (NIV).Two approaches are associated with the use of NIV in palliative care settings. In the "palliative approach", NIV is proposed for patients with end stage of chronic respiratory failure and do-not-tracheostomize orders as a ceiling of care. In the "palliative and probably curative" approach, NIV may help patients with do-not-intubate orders or to forego endotracheal intubation. This review provides some guidelines for clinicians responsible for patients with incurable illness, to help to guide and anticipate the medical management if acute respiratory failure (ARF) develops.NIV may palliate symptoms in patients near the end of life. In the case of severe ARF in patients with do-not-intubate orders, NIV may avoid the need for endotracheal mechanical ventilation, most often in patients with COPD or cardiogenic pulmonary oedema. NIV may help some patients to forego endotracheal intubation. Future studies are needed to examine the attitudes of patients and families to this intervention.