Ongoing monitoring and optimisation of NIV

Troubleshooting and optimisation of NIV

Healthcare professionals should be aware of the individual factors that influence a patient’s adherence, the effectiveness of the ventilation and those patients who may be most at risk of ineffective NIV, for example patients with bulbar impairment.

In the following clip Rosie Whitehead, a Respiratory Physiotherapist, describes some of the problems that can cause poor tolerance and to how to manage these.

Potential problems with the mask

Learn more about troubleshooting steps by clicking on the problems below.

Poor mask fit

Nose or face soreness

Dry eyes or irritation

Mask leak

Poor mask fit results in nose and face soreness, dry eyes, poor ventilation, discomfort and poor tolerance. If mask fitting is difficult, a face-to-face assessment may be appropriate, particularly as disease progresses.

Protective pad for masks

Potential problems causing poor tolerance of NIV

Excessive oropharyngeal or respiratory

Dry mouth or thickened oropharnygeal or respiratory sections



Increasing dependence on NIV

Patient wearing a oronasal mask

Patient wearing a oronasal mask

Potential problems with the ventilation

New or poorly controlled symptoms of respiratory failure


Low tidal volumes

Address mask leak.

Upper airway events

Premature expiratory effort

Auto-cycling asynchronies

Ventilator not triggering despite patient effort

Good practice points