In which situation is NIV contraindicated due to anatomical limitations?

Noninvasive ventilation (NIV) relies on proper application of a mask or interface to deliver positive pressure support and assist with breathing. For NIV to be effective, a proper fit is essential to create a sufficient seal that prevents air leakage and allows for optimal pressure delivery.

Severe facial or skull abnormalities can significantly impair this fit, thereby compromising the efficacy of the ventilation. In such cases, the physical structure of the face or skull may prevent the mask from making appropriate contact with the skin or create gaps that lead to inadequate ventilation. This could render NIV ineffective or unsafe for the patient as it may not provide the necessary respiratory support.

In contrast, mild obesity, chronic obstructive pulmonary disease (COPD), and transient respiratory distress do not inherently present anatomical barriers that would prohibit the successful use of NIV. Although these conditions may complicate management or require careful consideration in monitoring and adjustments, they do not necessarily make NIV contraindicated due to anatomical limitations.