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Review
. 2026 Mar 1;16(1):59-65.
doi: 10.4103/mgr.MEDGASRES-D-24-00129. Epub 2025 Jun 28.

Gas mixture in noninvasive ventilation

Mostafa Elshazly  1 , Garuti Giancario  2 , Benan Bayrakci  3 , Jose Luis Sandoval  4 , Hebatallah Hesham Ahmed  1 , Antonio M Esquinas  5
Affiliations
Review

Gas mixture in noninvasive ventilation

Mostafa Elshazly et al. Med Gas Res. .

Abstract

Noninvasive ventilation (NIV) and high-flow nasal cannula are increasingly used to treat acute respiratory failure. Because many of these patients could also benefit from inhaled medications, combining aerosol therapy with NIV or high-flow nasal cannula is a promising approach. Effective drug delivery to the lungs is crucial for successful aerosol therapy during NIV. Prior research has identified several factors that affect aerosol delivery efficiency in NIV patients. Medical gases have a long history of use in managing various respiratory conditions. Among them, oxygen is frequently used for patients with hypoxia (e.g., hypoxemic respiratory failure and in newborns). In addition to deoxygenation, helium oxygen mixture and nitric oxide can also be administered through devices such as masks combined with NIV. This narrative review aims to provide a comprehensive overview on the application of gas mixtures (such as helium oxygen mixtures and nitric oxide) in NIV, focusing on their efficacy, safety, and optimization strategies in different clinical settings.

Keywords: aerosol drug delivery; drug delivery systems; gas mixtures; heliox; helium-oxygen mixture; inhalation therapy; inhaled nitric oxide; metered-dose inhaler; nebulizer; noninvasive ventilation.

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Conflict of interest statement

Conflicts of interest: All authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
The recommended position for aerosol device is between the leak port and the mask. Created with OpenAI’s DALL·E under authors’ direct supervision to ensure scientific accuracy.
Figure 2
Figure 2
Full face mask.
Figure 3
Figure 3
Oronasal face mask. Oronasal face mask is often favored by clinicians.
See this image and copyright information in PMC

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