Abstract
Dyspnea is a distressing consequence of many unremitting diseases. This review discusses the therapeutic use of noninvasive ventilation (NIV) in advanced illness. NIV continues to be investigated most rigorously in patients with progressive neuromuscular weakness and the combination of emphysema and lung cancer. Data are quite limited on the palliative role of NIV in bronchiectasis and interstitial lung diseases. It remains difficult to identify the subsets of patients with acute-on-chronic respiratory failure who are most likely to benefit from ICU admission, but NIV may particularly help those with hypercapnia. The question of whether general or disease-specific instruments should be used to evaluate the effects of NIV on quality of life is unanswered. Computerized decision aids have been developed to assist providers, patients, and their families with advance care planning. NIV is an important adjunct to medications for patients with intractable dyspnea. Future research should attempt to clarify the effectiveness of NIV at controlling dyspnea within and outside the hospital. Barriers to its domiciliary application are largely unknown. Processes should be developed to optimize communication among clinicians, patients, and their caregivers around the issues of when to start NIV and how to withdraw it at the end of life.
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