PT - JOURNAL ARTICLE AU - Raffaele Scala AU - Lara Pisani TI - Noninvasive ventilation in acute respiratory failure: which recipe for success? AID - 10.1183/16000617.0029-2018 DP - 2018 Sep 30 TA - European Respiratory Review PG - 180029 VI - 27 IP - 149 4099 - http://err.ersjournals.com/content/27/149/180029.short 4100 - http://err.ersjournals.com/content/27/149/180029.full SO - EUROPEAN RESPIRATORY REVIEW2018 Sep 30; 27 AB - Noninvasive positive-pressure ventilation (NPPV) to treat acute respiratory failure has expanded tremendously over the world in terms of the spectrum of diseases that can be successfully managed, the locations of its application and achievable goals.The turning point for the successful expansion of NPPV is its ability to achieve the same physiological effects as invasive mechanical ventilation with the avoidance of the life-threatening risks correlated with the use of an artificial airway.Cardiorespiratory arrest, extreme psychomotor agitation, severe haemodynamic instability, nonhypercapnic coma and multiple organ failure are absolute contraindications for NPPV. Moreover, pitfalls of NPPV reduce its rate of success; consistently, a clear plan of what to do in case of NPPV failure should be considered, especially for patients managed in unprotected setting. NPPV failure is likely to be reduced by the application of integrated therapeutic tools in selected patients handled by expert teams.In conclusion, NPPV has to be considered as a rational art and not just as an application of science, which requires the ability of clinicians to both choose case-by-case the best “ingredients” for a “successful recipe” (i.e. patient selection, interface, ventilator, interface, etc.) and to avoid a delayed intubation if the ventilation attempt fails.NIV has to be considered a “rational art” which requires the ability of clinicians to choose case by case the best “ingredients” for a “successful recipe”, avoiding a delayed intubation in case of failure http://ow.ly/hBH930koclL