Tailoring non-invasive respiratory supports in acute hypoxemic respiratory failure: A practical approach for clinicians.

Pittao, Maria Laura Vega; Nava, Stefano; Hill, Nicholas S; Pisani, Lara · Eur J Intern Med · 2025

review · Level V

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Abstract

The use of non-invasive respiratory support (NIRS) for acute respiratory failure (ARF), particularly hypoxemic respiratory failure, has advanced in recent years, especially during the COVID-19 pandemic. NIRS modalities like high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and non-invasive ventilation (NIV) have shown efficacy, though evidence is inconsistent, especially for "de novo" acute hypoxemic respiratory failure (AHRF). This review outlines the physiological rationale for NIRS and offers practical guidance on tailoring treatment to individual patients. Successful AHRF management with NIRS requires a personalized approach, guided by clinical expertise. Further research is needed to refine patient selection and optimize NIRS application.

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