ERS Practical Handbook Noninvasive Ventilation Introduction 1 The history of NIV is an intertwining chronicle of the development of negative and positive pressure modes, as at different times in history, each mode has dominated. For example, in the mid-1980s, all patients using respiratory support received NPV, whereas the vast majority of our patients now use positive-pressure NIV, and there are hundreds of thousands of individuals with sleep apnoea world- wide receiving CPAP and many thousands using NIV for respiratory failure. Indeed, the history of NIV dates right back to the beginning: “And the LORD God formed man of the dust of the ground, and breathed into his nostrils the breath of life and man became a living soul”. Genesis 2: 7 So NIV existed before invasive ventilation! More scientifically, from an invasive ventilation perspective, there are descriptions going back to antiquity of trache- ostomy, and these are found in the medieval period and 1500s too. Vesalius, in the 16th century, was aware that positive pressure applied to the trachea would inflate the lungs and Hooke demonstrated that it was possible to keep a dog alive by applying bellows to the upper airway in 1667. For verifiable human accounts, we need to advance to the 18th century – and first deal with NPV. Woollam (1976) credits John Dalziel, a Scot, as the first to describe a tank ventila- tor/iron lung type device and a fellow Scot, Alexander Graham Bell, developed the notion further. Bell is best known for inventing the forerunner of the telephone in 1876 but, in 1881, his first child Edward died of respiratory distress a few hours after birth. The story goes that shortly afterwards Bell was walking along a shingle beach in Ontario when the idea of a negative-pressure jacket to assist the breath- ing of infants came to him. He went on to patent this device. Figure 1 is an extract from his notebook, although it is quite difficult to decipher. NIV: past, present and future Anita K. Simonds Key points • The development of negative- and positive-pressure NIV is inextricably linked. • NIV is one of the most evidence-based areas of respiratory medicine and indications for NIV continue to increase in number.