Non-invasive ventilation at the end of life. Ethical aspects

The value of non-invasive ventilation (NIV) at the end of life is not sufficiently well known. This must be considered when NIV is used to palliate dyspnea. This explains the different statements made by scientific societies in different countries. However, as survey results have shown, NIV is used relatively often in clinical practice. NIV should be used if patients have made an advanced directive to forego endotracheal intubation but not mechanical ventilation. The indication is valid especially in situations with evidence-based ef-fectiveness of NIV, such as acute exacerbation of chronic obstructive pulmonary disease or cardiogenic lung edema. The individual indications for NIV should be evaluated in a shared decision-making process after careful discussion of the determinants of success and failure, which are expressions of good medical care for the patient.