Introduction The onset of severe, life threatening respiratory failure in patients with an incurable illness may be an indication for the use of non-invasive ventilation (NIV).

State of the art Two approaches are associated with the use of NIV in palliative care settings. In the “strictly palliative” approach, NIV is proposed for patients with end stage, chronic respiratory failure and “do-not-tracheostomise” orders as a ceiling of care. In the “palliative and probably curative” approach, NIV may help patients with “do-not-intubate” orders or enable them to forego endotracheal intubation. This review provides some guidelines for clinical practitioners in charge of patients with incurable illnesses, to help to guide and anticipate their medical management if acute respiratory failure (ARF) develops.

Conclusions and perspectives NIV can alleviate symptoms in patients near the end of life. In the case of severe ARF in patients with “do-not-intubate” orders, NIV may also be used to avoid the need for endotracheal mechanical ventilation, usually in patients with COPD or cardiogenic pulmonary oedema. NIV may help some patients to forego endotracheal intubation. Future studies are needed to examine the attitude of patients and their families to this technique.