TY - JOUR T1 - Unusual applications of non-invasive ventilation JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/09031936.00192810 SP - erj01928-2010 AU - N. Ambrosino AU - F. Guarracino Y1 - 2011/01/01 UR - http://erj.ersjournals.com/content/early/2011/02/24/09031936.00192810.abstract N2 - The use of non invasive mechanical ventilation (NIV) in acute hypercapnic respiratory failure, cardiogenic pulmonary oedema, acute lung injury/acute respiratory distress syndrome (ARDS), community-acquired pneumonia, weaning/post-extubation failure is considered common in clinical practice. We review the use of NIV in unusual conditions.Evidence supports the use of NIV during fiberoptic bronchoscopy especially with high risks of endotracheal intubation (ETI), such as in immunocompromised patients. During trans-esophageal echocardiography as well as in interventional cardiology and pulmonology, NIV can reduce the need of deep sedation or general anaesthesia and prevent respiratory depression induced by deep sedation. NIV may be useful in postsurgery including cardiac surgery, and with lower level of evidence in patients with pulmonary contusion. NIV should not be considered as an alternative to ETI in severe communicable airborne infections likely to progress to ARDS. NIV is being used increasingly as an alternative to ETI in end-stage symptomatic patients, especially to relief dyspnoea. The role of assisted ventilation during exercise training in COPD patients is still controversial.NIV should be applied under close monitoring and ETI should be promptly available in the case of failure. A trained team, careful patient selection and optimal choice of devices, can optimise outcome of NIV. ER -