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It is different to use NIV at an early stage of respiratory failure (for instance when the Pao2/Fio2 ratio is Cefaloridine Another limitation is the self-reporting by sites, which introduces the risk of selection bias. Healthcare workers were not prospectively assessed with follow-up serologies and the safety of the procedure should be investigated. Although no official notification of nosocomially transmitted cases has been reported using this therapy, the technique must be applied using the security selleckchem measures recommended by the CDC guidelines and many scientific societies. In spite of recommendations against its use and these limitations, clinicians used NIV in nearly half of this large multicentre cohort, and in a significant proportion it was successful, suggesting that patients with severe acute respiratory infection can take benefit from early non-invasive oxygenation techniques. A randomized clinical trial is warranted to determine which patients may benefit from these Carfilzomib techniques, to improve prognosis and to help reduce healthcare costs. In conclusion, clinicians used NIV in 25.8% of patients with influenza A (H1N1)v viral pneumonia admitted to ICU and treatment was effective in 40.6% of them. NIV was successful in patients who presented with fewer than two chest X-ray opacities with haemodynamic stability and SOFA score ��7. NIV failure was associated with a mortality similar to that in patients who were intubated from the start. Drs Masclans and Rello contributed to the conception and design of this study, acquisition of data, analysis and interpretation of data, and manuscript preparation. Both are guarantors of the paper, taking responsibility for the integrity of the work as a whole. Drs P��rez, Socias, Marques, Vidaur, Lorente and Almirall contributed to the acquisition of data, analysis and interpretation of data, and manuscript preparation. Investigators from 148 ICUs of GTEI/SEMYCIUC contributed to the acquisition of data, and are listed in the Appendix. In addition, Dr Perez was specifically responsible for statistical analysis.