Initiation of non-invasive ventilation (CPAP or NIMV) as primary respiratory support or in the post-extubation setting is now well accepted and reasonably protocolized. However, selection of an appropriate interface remains contentious. Several authors have attempted to answer this clinically relevant question using various study designs (including secondary research with systematic reviews and inferential analysis) [
1]. We seemed to have reached a stalemate for most outcome measures: nasal injury, failure of NIV, duration of mechanical ventilation and physiological measures of airway resistance/ leaks and the likes. The systematic review conducted by Kumar et al., published in this issue of the journal, concluded similar rates of moderate to severe nasal injury with use of continuous mask, continuous binasal prongs or periodic rotations of the two interfaces [
2]. Three studies qualified for final meta-analysis. Overall, there was lesser nasal injury with continuous mask and rotations as compared to continuous use of binasal prongs. …