Home non-invasive ventilation in chronic respiratory failure: Evidence-based guidelines
Year: 2026
Type: article
Abstract: ABSTRACT: Home non-invasive ventilation (NIV) is used across a range of causes of chronic respiratory failure, but patient selection and management are disease-specific. These guidelines provide evidence-based recommendations on initiating, titrating, and monitoring long-term home NIV across different disease spectrums. The panel reviewed studies from international databases, relevant guidelines, and reference lists. The panel refined recommendations through two rounds of consensus and graded them using the Indian Chest Society framework. In chronic obstructive pulmonary disease (COPD), home NIV is recommended for eligible patients with persistent daytime hypercapnia, including those who remain hypercapnic 2 to 4 weeks after an exacerbation. High-intensity bilevel ventilation should be titrated to achieve a meaningful reduction in arterial carbon dioxide. In neuromuscular disorders, respiratory muscle weakness or hypoventilation warrants timely assessment for NIV, alongside evaluation of interface tolerance and secretion clearance. For stable obesity hypoventilation syndrome with severe obstructive sleep apnoea, continuous positive airway pressure is generally the preferred initial treatment; NIV is appropriate when severe obstructive sleep apnoea is absent or continuous positive airway pressure fails or is not tolerated. The guidelines also address heart failure with sleep-disordered breathing, chest-wall deformity, interstitial lung disease, bronchiectasis, post-tuberculosis lung disease, central hypoventilation syndromes, and palliative care. Across indications, management should include individualised ventilator settings, objective assessment of ventilation, patient and caregiver education, and structured follow-up. Where evidence is limited, recommendations reflect expert consensus and should be applied in the context of patient goals, clinical feasibility, and available resources.
Source: Lung India
Authors: Gopi C. Khilnani, Pawan Tiwari, Saurabh Mittal, Raja Dhar, D. J. Christopher, J. C. Suri, Virendra Singh, Dhruva Chaudhry, Amita Nene, Rajesh Swarnkar, Radha Munje, Parvaiz A Koul, Kunal Ahuja, Pawan K. Singh, Manju Nath, Anant Mohan, Vijay Hadda, A. R. Parmez, Nitin Abhiyankar, Indranil Halder, Tejas M. Suri, Mansi Gupta, Amrita Bhattacharya, Rohit Kumar, Aman Ahuja, Nitin Jain, Rakesh Chawla, J. K. Samaria
Institutions: Pushpawati Singhania Research Institute, All India Institute of Medical Sciences, Christian Medical College, Vellore, Fortis Flt. Lt. Rajan Dhall Hospital, University of Rajasthan, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Bombay Hospital, Getwell Hospital and Research Institute, Government Medical College, Indira Gandhi Government Medical College & Hospital, Sher-i-Kashmir Institute of Medical Sciences, Medicover Hospitals, Rajagiri Hospital, College of Medicine & JNM Hospital, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Safdarjang Hospital, Vardhman Mahavir Medical College & Safdarjung Hospital, Rajiv Gandhi Cancer Institute and Research Centre, Jaipur Golden Hospital, Banaras Hindu University
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223098192