Non-Invasive Ventilation (NIV)

This page brings together guidance and resources aimed at those involved in the delivery of non-invasive ventilation (NIV). 


This document has been developed in response to the NCEPOD Inspiring Change report and new Quality Standards and sets out information that may be useful when setting up a QI project aimed at improving NIV care. A number of example documents are included as appendices. 

Appendix 1: Improving NIV Through Understanding, an example NIV QI project
Appendix 2: Example of a patient feedback questionnaire (ICHT)
Appendix 3: Example patient information leaflet (ICHT)
Appendix 4a: NIV algorithm (BTS)
Appendix 4b: NIV algorithm (ICHT)
Appendix 5: Example NIV prescription (Sherwood Forest Hospitals)
Appendix 6: Example electronic NIV observation chart (EPIC)
Appendix 7a: Example NIV care bundle (ICHT)
Appendix 7b: Example NIV care bundle (BTS)
Appendix 8: Example of a Clinical Competency Assessment Framework (ICHT)
Appendix 9: Suggested levels of competency (BTS)

Copyright: Trusts are welcome to adapt the appendices to local requirements. Each document contains details of the authors and/or source organisation – please acknowledge the authors/source in any materials produced using these appendices.


The next BTS National NIV Audit will run in Feb-Mar 2019 and has been included in the NHS England Quality Accounts List for 2018/19. Audit questions have been updated to reflect the recommendations from the NCEPOD Inspiring Change report and new Quality Standards. For further details, please log in or register for the BTS audit system.

BTS Guidelines

The BTS/ICS Guidelines for the Ventilatory Management of Acute Hypercapnic Respiratory Failure in Adults were published in Thorax in March 2016 and replace the 2008 Guidelines on NIV for COPD patients.

NCEPOD Report: Inspiring Change - A review of the quality of care provided to patients receiving acute non-invasive ventilation

This study explored avoidable and remediable factors in the process of care for patients treated with acute NIV. The study was proposed by BTS after successive BTS national audits identified suboptimal outcomes, high mortality rates and significant variation. The study report, published in July 2017, includes robust recommendations that can be used to improve NIV services. 

BTS Quality Standards

BTS Quality Standards for acute non-invasive ventilation in adults, were published in April 2018. These identify six key indicators of quality care and provide information on how to measure attainment against these standards. 


November 2018