Home non-invasive ventilation in chronic respiratory failure: Evidence-based guidelines

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.