Tolerance of higher IPAP levels can last from minutes to several days or even weeks: individual adjustment is inevitable. Sometimes significant modification of settings is feasible at the first control in-hospital visit after having discharged patients for acclimatisation in the home environment.

In cases of co-existing upper airway obstruction, higher EPAP levels are required. On the other hand, higher EPAP reduces the effective IPAP (which is IPAP minus EPAP); thus, avoid high EPAP levels if not required.

For controlled NPPV (final aim), respiratory rates are typically set to 1 breath·min⁻¹ higher than during spontaneous breathing; thus, avoid excessively high respiratory rates, even though controlled ventilation is the aim.

Try out several masks. For nocturnal NPPV, use oronasal masks because of potentially substantial leakage; for daytime NPPV, a nasal mask is often better tolerated. Again: individual adjustment is mandatory.

Several days in hospital are usually necessary to establish high-intensity NPPV.

Use humidification in cases of dry mucous membrane.

Leakage is unavoidable, but should be kept as low as possible.

Gastrointestinal side-effects can be managed by medication, positioning and adjustment (reduction) of ventilator settings; here, pressure-limited NPPV is superior to volume-limited NPPV.

Care must be taken in patients with pre-existing cardiac disease as high-intensity NPPV may induce a reduction in cardiac output.