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Experience of acute noninvasive ventilation—insights from ‘Behind the Mask’: a qualitative study
  1. Tracy A Smith1,2,
  2. Meera Agar3,4,
  3. Christine R Jenkins5,6,
  4. Jane M Ingham1,7 and
  5. Patricia M Davidson8,9
  1. 1 Faculty of Medicine, UNSW Australia, St Vincent's Clinical School, Sydney, New South Wales, Australia
  2. 2 Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, New South Wales, Australia
  3. 3 Palliative Care Unit, Braeside Hospital, Hammond Care, Sydney, New South Wales, Australia
  4. 4 Discipline of Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia
  5. 5 Department of Thoracic Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
  6. 6 Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
  7. 7 St Vincent's Health Network, Sydney, New South Wales, Australia
  8. 8 School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
  9. 9 Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Tracy Smith, Department of Respiratory Medicine, Westmead Hospital, PO Box 533, Wentworthville, NSW 2145, Australia; Tracy.smith2{at}


Objective Non-invasive ventilation (NIV) is widely used in the management of acute and acute-on-chronic respiratory failure. Understanding the experiences of patients treated with NIV is critical to person-centred care. We describe the subjective experiences of individuals treated with NIV for acute hypercapnic respiratory failure.

Design Qualitative face-to-face interviews analysed using thematic analysis.

Setting Australian tertiary teaching hospital.

Participants Individuals with acute hypercapnic respiratory failure treated with NIV outside the intensive care unit. Individuals who did not speak English or were unable or unwilling to consent were excluded.

Results 13 participants were interviewed. Thematic saturation was achieved. Participants described NIV providing substantial relief from symptoms and causing discomfort. They described enduring NIV to facilitate another chance at life. Although participants sometimes appeared passive, others expressed a strong conviction that they knew which behaviours and treatments relieved their distress. Most participants described gaps in their recollection of acute hospitalisation and placed a great amount of trust in healthcare providers. All participants indicated that they would accept NIV in the future, if clinically indicated, and often expressed a sense of compulsion to accept NIV. Participants' description of their experience of NIV was intertwined with their experience of chronic disease.

Conclusions Participants described balancing the benefits and burdens of NIV, with the goal of achieving another chance at life. Gaps in recall of their treatment with NIV were frequent, potentially suggesting underlying delirium. The findings of this study inform patient-centred care, have implications for the care of patients requiring NIV and for advance care planning discussions.

  • Heart failure
  • Chronic obstructive pulmonary disease
  • Respiratory conditions
  • noninvasive ventilation
  • Advance care planning

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