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👉🏼 We highlight a narrative review on Non-Invasive Respiratory Support in the ICU, authored by Dr. Jean-Pierre Frat (Faculté de Médecine et de Pharmacie de Poitiers, Université de Poitiers, France) and collaborators with extensive clinical and scientific experience in the field, published in Intensive Care Med 2025.

👉🏼 The article reviews several well-established aspects and others that remain controversial.

🧐 Below are 5 key points we highlight from the article that deserve careful reading and discussion:

1  High-Flow Nasal Cannula (HFNC) is recommended as first-line therapy for acute hypoxemic respiratory failure (AHRF), as it reduces the risk of intubation.

2  There is no consensus on the use of NIV or CPAP in AHRF management, although helmet interfaces allow for higher levels of PEEP or CPAP and may offer better outcomes.

3  NIV is the reference treatment for COPD exacerbations with respiratory acidosis. HFNC has not shown good efficacy in more severe COPD exacerbations.

4  Prophylactic NIV is the most effective method to avoid reintubation in high-risk patients, while HFNC may be used in low-risk patients.

5  For preoxygenation prior to intubation, NIV is the first choice. HFNC is a viable alternative for non-hypoxemic patients or those with contraindications to NIV.

🔗 Click the link below to access the full article. Enjoy the read and take time to reflect.

Frat, JP., Grieco, D.L., De Jong, A. et al. Noninvasive respiratory supports in ICU. Intensive Care Med (2025). https://doi.org/10.1007/s00134-025-08036-3