Developed by the Respiratory Health Implementation Group (RHIG), the All-Wales Acute NIV guideline standardises the diagnostic process for acute hypercapnic respiratory failure, recognising which patients would benefit from NIV, and optimising therapy and stabilise acute acidosis using one simple pathway.

Key recommendations:

• Confirm the presence of hypercapnic respiratory failure and document the patient's ceiling of care
• Initial management steps to optimise a patient before initiating non-invasive ventilation
• Timely access to NIV and appropriate escalation of therapy, using three separate approaches for different disease groups