Presse Med
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When first developed in the fifties and sixties during the major polio epidemics, artificial ventilation was a major advance in medical care. The negative pressure perithoracic "iron lungs" had however many disadvantages and were widely replaced by positive pressure ventilation with intubation. This invasive technique allows normalization of gas exchange but has the disadvantage of requiring artificial sedation of the respiratory muscles in many cases in addition to the risk of secondary complications. ⋯ Other inconveniences include leaks around the mask and the need for careful surveillance by the health care workers. Today, there are several arguments based on prospective clinical studies showing that intubation may be avoided in certain patients by using non-invasive positive pressure ventilation with a nasal mask. Careful patient selection is however essential in addition to knowledge of the limitations of the technique.