Noninvasive ventilators are not only widely used for the treatment of inpatients with acute or chronic respiratory failure because they do not require the patient to be given a tracheal intubation or tracheotomy, their operation is simple and easily accepted by the patient, and they have few complications such as airway injury and ventilator-associated pneumonia, and their home application is also increasing for outpatients with relatively stable conditions. The main diseases that need to be treated with non-invasive ventilators at home include obstructive sleep apnea hypoventilation syndrome (OSAHS), cardiac failure, chronic obstructive pulmonary disease (COPD) respiratory failure, obesity hypoventilation syndrome and neuromuscular diseases. How to properly select the appropriate non-invasive ventilator and ventilation mode to ensure the therapeutic effect and safety has always been a concern for clinicians and patients. The ventilator is not a general daily appliance, and its use requires continuous technical support and maintenance from service providers, and moreover, follow-up and adjustment by clinicians. This article discusses the types and characteristics of non-invasive ventilators for different diseases mentioned above, with the aim of helping patients who need to choose a home ventilator. Although there is some overlap in the therapeutic effects of different types of ventilators (i.e., sometimes the same type of ventilator may be used for patients with different diseases and vice versa), the requirements for selecting the type of ventilator are different for each disease based on the mechanism of occurrence and the purpose of treatment. The type and severity of the disease is an important basis for selecting different types of ventilators and thus ensuring efficacy and safety. 1.Sleep apnea Continuous positive airway pressure (CPAP) ventilation is still the preferred treatment recommended by the guidelines for obstructive sleep apnea hypoventilation syndrome, providing a constant pressure during breathing to maintain the upper airway open, especially during the expiratory phase. CPAP is most often used in OSAHS to effectively eliminate apnea and hypoventilation during sleep, avoid hypoxic damage, improve sleep quality to relieve patients’ daytime sleepiness, and reduce the risk of comorbidities such as cardiovascular disease. Patients with other conditions such as overlap syndrome (having both COPD and OSAHS) and chronic heart failure-associated respiratory breathing disorders may also benefit from Fixed-CPAP treatment requires pressure titration under polysomnographic monitoring in the sleep laboratory. The goal of the titration is to determine an optimal pressure to eliminate or reduce apnea, hypoventilation, snoring, and arousals associated with respiratory effort, with criteria for judging the quality of the titration. The optimal pressure determined by titration is used as the basis for the pressure setting of the home CPAP ventilator.Fixed-CPAP noninvasive breathing is effective and inexpensive, and is the most common type currently used to treat OSAHS.Auto-CPAP is a CPAP device that works by automatically titrating the pressure. It automatically senses the degree of airway obstruction and its variability and automatically adjusts the pressure to open the airway, thus Auto-CPAP overcomes the shortcomings of CPAP to a certain extent and reduces the need for manual pressure titration, but it should be noted that Auto-CPAP does not completely replace manual pressure titration. Regardless of the type of ventilator treatment, it still needs to be adjusted by a medical professional or respiratory therapist according to the condition and outcome of use. Nonetheless, some studies have shown that its efficacy for OSAHS does not compare favorably with traditional fixed CPAP, and it is more expensive. Auto-CPAP is not currently recommended by the American Sleep Association for the routine diagnosis and treatment of OSAHS, nor is it recommended for the treatment of other non-obstructive sleep disorders caused by cardiopulmonary vascular disease or other causes of nocturnal hypoxemia. If a patient with obstructive sleep apnea has a long duration, often combined with central sleep apnea or pressure titration pressure is too high to be tolerated, a Bi-level positive airway pressure ventilation (BiPAP) ventilator can be used and needs to have a backup frequency, and if economic conditions allow the best solution is a ventilator with ASV mode. In the case of central sleep apnea, the commander of the “brain” deserted and intermittently gave breathing instructions causing interruption of respiratory airflow, which cannot be ventilated with continuous positive airway pressure (CPAP), but with pressure support mode – bi-level positive airway pressure ventilation (BiPAP), which can be specifically divided into S / T, ASV (Adaptive Airway Pressure Ventilation), and ASV (Adaptive Airway Pressure Ventilation). T, ASV (Adaptive Servo Ventilation), etc. Chronic obstructive pulmonary disease combined with respiratory failure Chronic obstructive pulmonary disease in the late stage or acute exacerbation of the disease will appear respiratory failure, then need bi-level positive airway pressure ventilation ventilator (BiPAP) to assist patients to breathe, through the exhalation phase pressure against the endogenous PEEP, reduce the retention of gas in the lungs, and inspiratory pressure to help gas into the lungs, reduce the patient’s breathing difficulties, discharge the body Excess carbon dioxide is expelled from the body. Compared to CPAP, BiPAP is used more widely, not only for the treatment of chronic obstructive pulmonary disease, but also for chronic respiratory diseases such as alveolar hypoventilation (i.e., having increased blood carbon dioxide during the day.) BiPAP is divided into two modes: without standby controlled ventilation frequency (BiPAP-S) and with standby controlled ventilation frequency (BiPAP-S/T). BiPAP can provide a BiPAP is also more commonly used for contouring pleural disease causing restrictive ventilation dysfunction, severe stable COPD, obesity hypoventilation syndrome treated with CPAP Patients with chronic heart failure such as alveolar hypoventilation (i.e., increased blood carbon dioxide during the day) and combined central sleep apnea syndrome and/or Chen-Schiff’s respiration should be treated with a ventilator with BiPAP-S/T mode to ensure efficacy and safety in patients with unstable respiratory center, combined central sleep apnea or Chen-Schiff’s respiration, but the best way is still ASV mode ventilator. 3. Cardiac failure The application of noninvasive ventilator therapy for cardiac insufficiency is a safe and effective measure with sufficient evidence-based medical evidence and has been written into textbooks. Positive pressure ventilation can increase intrathoracic pressure to reduce the amount of return blood, provide diuresis and similar effects without the side effects of electrolyte disturbances, in addition to reducing other loads on the heart. In most patients with cardiac insufficiency, continuous positive airway pressure (CPAP) ventilation is appropriate and does not require high pressure to achieve the desired effect. Because the incidence of obstructive sleep apnea is much higher in patients with cardiovascular disease than in the normal population, we encounter many patients with heart failure combined with obstructive sleep apnea, and also many patients with central sleep apnea, which can be improved to some extent by oxygenation, but most of them require noninvasive ventilation, unlike other central apnea that requires bi-level positive pressure ventilation. Unlike other central apneas that require dual-level positive pressure ventilation, most central sleep apneas in heart failure can be corrected with continuous positive airway pressure (CPAP), and auto-CPAP is not recommended here. Adaptive servo-ventilation (ASV) can be used to treat patients with heart failure with central apnea syndrome and/or Chen-Schroeder respiratory CPAP therapy, but is not recommended for severe heart failure (patients with ejection fraction less than 0.45) according to a recent study.ASV can also be used to treat complex sleep apnea syndrome and mixed sleep apnea syndrome.ASV usually ASV has the advantage of stabilizing breathing and avoiding central apnea induced by high support pressures that lower carbon dioxide. 4. Neuromuscular disease Neuromuscular disease can account for up to one-third of patients treated with home noninvasive ventilators in some European countries, while we have much less in China. Focusing on respiratory failure in patients with neuromuscular diseases, we have a lot of work to do. Early administration of noninvasive ventilator-assisted ventilation can delay respiratory muscle failure, preserve the patient’s ability to cough up sputum, and reduce the risk of pneumonia. A bi-level positive airway pressure ventilator should be used, and the inspiratory pressure (IPAP) should be carefully adjusted according to the patient’s muscle strength and tidal volume, etc., to obtain the best results. In recent years, the model of setting a target tidal volume or alveolar ventilation volume can adjust the pressure according to the preset tidal volume (usually 6-8 ml/kg standard body weight) when the patient’s inspiratory effort, airway resistance, or lung or chest compliance changes, which is sufficient to ensure a relatively stable tidal volume and enable the machine to adapt to changes in disease when there is deterioration such as acute exacerbation of COPD and progressive neuromuscular disease The machine is able to adapt to changes in the disease, such as acute exacerbation of COPD and progressive neuromuscular disease, by increasing the support pressure in time to ensure the ventilation volume and thus the efficacy. The ventilator with high-frequency function developed by Cadet has a special advantage for such patients as it can promote the expulsion of sputum. After wearing the ventilator, it is important to check the ventilator testing parameters according to the condition and adjust them in time to achieve the best treatment effect. As a respiratory physician, the last thing you want to see is a patient being re-hospitalized for respiratory failure soon after wearing the ventilator. resmed’s newly launched ventilator in Australia offers remote monitoring and management capabilities, but unfortunately resmed does not currently offer this remote service to markets outside of Australia. We in China are proud that Cadet, a company founded by Dr. Sun Jianguo, one of the first Thousand Talents Program experts in China, launched the Lotus series of ventilators with remote monitoring capabilities as early as the end of 2012, giving our domestic patients more options. So how can the existing ventilators without remote function improve doctor-patient communication and strengthen management? In order to provide individualized services to more patients Shandong University Qilu Hospital has established a respiratory IOT platform integrated with the Internet and cell phone applications, providing each patient with an account in the cell phone application using an OTG card reader to upload the monitoring data on the SD card of the ventilator, the doctor will upload the report after analyzing the data, the patient can automatically receive and read the report on the cell phone, and if the doctor thinks it is necessary to adjust the parameters The configuration file can be changed and sent back to the Respiratory IoT, and the patient can download the cell phone application to the respirator to automatically configure the new parameters. In short, whether we take the traditional consultation or advanced IoT, we have to achieve the breathing and common between doctors and patients.