The Use of Noninvasive Positive Pressure Ventilation (NPPV)

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If you have a health condition that causes you to have trouble breathing, such as sleep apnea or chronic obstructive pulmonary disorder (COPD), your doctor may recommend noninvasive ventilation to help support your lung function. Also known as noninvasive positive pressure ventilation (NPPV), this type of mechanical ventilation assists a person in taking a full breath and helps to maintain adequate oxygen supply in the body, especially while sleeping.

You may already be familiar with noninvasive positive pressure ventilation if you have heard about or used a continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP), or auto-adjusting positive airway pressure (APAP) machine.

Purpose and Uses

Noninvasive ventilation provides ventilatory support to a person through the upper airways. NPPV is an alternative to invasive mechanical ventilation (being placed on a ventilator) for people who have chronic respiratory insufficiency or respiratory failure and can no longer breathe adequately on their own.

There are several conditions that may benefit from using NPPV.

  • COPD
  • Obstructive sleep apnea
  • Obesity hypoventilation syndrome
  • Asthma flare-ups

Your doctor may recommend NPPV for you if you have COPD and are experiencing an exacerbation that may result in hypercapnic respiratory failure, or if you have moderate to severe sleep apnea.

You may also need NPPV if you have dyspnea (the sensation of shortness of breath,) tachypnea (a rapid respiratory rate,) and/or hypercarbia (an elevated carbon dioxide level in the blood,) with a pH of between 7.25 and 7.35.

NPPV can also be used as a transition tool to move off of invasive mechanical ventilation, or in place of endotracheal intubation in select patients. Unlike invasive ventilation, which requires monitoring in the intensive care unit, noninvasive ventilation can frequently be performed in the general hospital ward, provided the staff is appropriately trained in its use.

How It Works

NPPV enhances the breathing process by providing a mixture of air and oxygen from a flow generator through a tightly fitted facial or nasal mask. Since the lungs are, in a way, held open by the positive pressure, it is easier to get oxygen down into the tiny alveoli where the exchange of oxygen and carbon dioxide take place.

In non-clinical terms, you may picture your alveoli as tiny balloons. Using this ventilatory support, the balloons stay slightly inflated after you breathe out, making their expansion easier with your next breath. The process is similar to filling a balloon while being careful to not let all of the air out between breaths to make it easier to fill.

Forms of NPPV

There are several forms of noninvasive positive pressure ventilation, including CPAP, BiPAP, and APAP. All three deliver pressurized oxygen through a mask, though they vary as to the ability to change settings.

Typically associated with sleep apnea treatment, the pressure delivered by PAP machines prevents the throat muscles from collapsing and restricting airflow.

  • CPAP: Continuous positive airway pressure is typically used in people who have obstructive sleep apnea. CPAP is set at a single constant level of pressure for both inhalation and exhalation.
  • BiPAP: Bilevel positive airway pressure has two settings: one for inhalation and one for exhalation. BiPAP is used more often for people with COPD since it is easier to exhale against a lower pressure, which this system allows for. A doctor will help calibrate the machine and choose your optimal settings.
  • APAP: Auto-adjusting positive airway pressure machines can actually calculate the necessary pressure for an individual's breathing comfort and automatically self-adjust. This "smart" device can be helpful if you have varied breathing patterns during the night, such as during different cycles of REM sleep, or if you move around a lot while sleeping.


A 2014 research paper published in Lancet found NPPV improved survival rates in people with COPD. The yearlong, randomized, multi-center, multinational study found that people with COPD who received noninvasive ventilation had a 36% lower risk of death.

Other studies show that NPPV used during acute COPD exacerbations reduces the need for endotracheal intubation (invasive mechanical ventilation) and is associated with a lower rate of treatment failure and shorter hospital stays.

In addition, a 2016 study found that long-term NPPV may result in improvements in arterial blood gasses (ABG), lung function, and health-related quality of life. In general, these improvements were much better with high-intensity noninvasive ventilation (using the highest possible inspiratory pressure) than with low-intensity NPPV.


People should not be treated with NPPV instead of mechanical ventilation if any of the following apply:

  • They are medically unstable because of hypotension (low blood pressure), sepsis (a severe generalized infection that can lead to shock), hypoxia (a deficiency in oxygen in the tissues of your body), or another life-threatening systemic illness
  • They have a worsening mental status
  • They are coping with excessive secretions, which put them at a higher risk of aspiration

A Word From Verywell

Only your doctor can determine if you are a candidate for noninvasive ventilation. NPPV is not appropriate for every person.

That said, studies showing both the reduced need for endotracheal intubation and improved survival rates for people with COPD who are candidates for NPPV are very encouraging. In addition, when looking at the long-term use of noninvasive ventilation with COPD, changes such as an improvement in blood gasses and lung function, as well as a better quality of life have recently been noted, particularly with high-flow NPPV. NPPV therapy has also made great strides in helping the millions who suffer from sleep apnea.

NPPV is only one measure of improving your quality of life if you have COPD, sleep apnea, or obesity hypoventilation syndrome. Be sure to talk to your doctor about other lifestyle changes that may help.

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