Non-invasive mechanical ventilation in hypoxemic respiratory failure: Just a matter of the interface?

In patients with acute respiratory failure the targets of mechanical ventilation are the improvement of pulmonary gas exchange and/or the unloading of the respiratory muscles. This can be achieved either invasively via an endotracheal tube or tracheostomy or noninvasively, for example via a mask. Although attempts of application of ventilation via a mask can be tracked back to the 16^th century, undoubtedly non-invasive mechanical ventilation (NIV) applied in the adult intensive care medicine, started some 20 years ago (1) and, in the meantime, has evolved to become the standard of care for many demands regarding pathological respiratory conditions; by avoiding the need for endotracheal intubation, its associated complications can be reduced and outcome is improved in selected patients (2-5).