Contraindications to noninvasive ventilation

Use of noninvasive ventilation is contraindicated in the following situations:

• immediate need for tracheal intubation
• cardiorespiratory arrest
• haemodynamic instability (eg hypotension)
• life-threatening hypoxaemia in patients who are candidates for intubation
• upper airway surgery
• impaired consciousness with inability to protect the airway
• fixed upper airway obstruction
• copious secretions or vomiting
• pneumothorax
• facial injuries, including fractured base of skull
• recent upper gastrointestinal surgery
• following transphenoidal resection of a pituitary tumour
• uncooperative patient or patient intolerant of the mask
• insufficiently trained staff to administer and monitor noninvasive ventilation.