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Noninvasive Respiratory Support for Acute Respiratory Failure
- Acute respiratory failure (ARF) is a leading cause of ICU admission, intubation, and initiation of mechanical ventilation.
- The American Thoracic Society (ATS) recently published its evidence-based clinical practice guideline on the use of noninvasive ventilation (NIV) in adults with ARF.
- The guideline focused on four categories: acute hypoxemic respiratory failure, acute hypercapnic respiratory failure, preoxygenation during endotracheal intubation, and post-extubation support.
- With respect to adult patients undergoing endotracheal intubation, ATS recommends the use of high-flow nasal cannula or noninvasive ventilation compared to standard oxygen therapy for preoxygenation.
- This strong recommendation is based on their pooled analysis of 15 randomized controlled trials, including over 3,000 patients, that demonstrated HFNC and NIV decreased the risk of peri-intubation hypoxemia compared to standard oxygen.
References
Noninvasive respiratory support for adult patients with acute respiratory failure: an official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2026; 22:2135-2158.