{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T13:28:04Z","timestamp":1793453284142,"version":"4.5.0"},"reference-count":194,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"NHLBI","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Fisher & Paykel"},{"DOI":"10.13039\/100012019","name":"Fondation du Souffle","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012019","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013347","name":"European Society of Intensive Care Medicine","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013347","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Hamilton Medical AG"},{"name":"Fisher & Paykel"},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Acute hypoxemic and hypercapnic respiratory failure are among the most common reasons for ICU admission and need for invasive mechanical ventilation. Noninvasive respiratory support (NIRS) strategies\u2014including high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), and continuous positive airway pressure (CPAP)\u2014may prevent intubation, improve outcomes, and reduce ICU utilization. However, there is uncertainty regarding optimal patient and modality selection, resulting in variable implementation. There are no clinical practice guidelines comprehensively addressing the use of the different NIRS strategies across the spectrum of acute respiratory failure.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To update and develop new evidence-based clinical practice recommendations informing NIRS use, including HFNC, NIV and CPAP, in adults with acute respiratory failure.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A multidisciplinary panel used the Grading of Recommendations, Assessment, Development, and Evaluation approach to address four PICO (Population, Intervention, Comparator, Outcome) questions related to the use of NIRS for hypoxemic and hypercapnic respiratory failure, preoxygenation for intubation, and postextubation respiratory support. Recommendations were informed by several systematic reviews and network meta-analyses.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The panel made a strong recommendation for HFNC and a conditional recommendation for NIV or CPAP for adults with acute hypoxemic respiratory failure with close monitoring for the need for escalation of respiratory support, based primarily on effects on need for intubation. For acute hypercapnic respiratory failure, the panel made a strong recommendation for NIV to reduce mortality and need for invasive mechanical ventilation, and a conditional recommendation for HFNC only in patients with less severe hypercapnia and with mild acidemia (eg, pH\u2009&gt;\u20097.25), provided that close monitoring and prompt escalation to NIV are available. The panel made a strong recommendation for HFNC or NIV for preoxygenation prior to endotracheal intubation to prevent peri-intubation hypoxemia. The panel also issued a risk-based recommendation, suggesting HFNC for low-risk patients and NIV for high-risk patients to reduce the need for re-intubation following extubation after critical illness.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Noninvasive respiratory support strategies are effective in improving outcomes in a range of clinical scenarios. We provide evidence-based recommendations, which can be further informed by patient risk, institutional capacity, and interface tolerance.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/ajrccm\/aamag302","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T16:41:37Z","timestamp":1782751297000},"page":"2135-2158","source":"Crossref","is-referenced-by-count":8,"title":["Noninvasive respiratory support for adult patients with acute respiratory failure: an official American Thoracic Society Clinical Practice Guideline"],"prefix":"10.1093","volume":"212","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7295-2033","authenticated-orcid":false,"given":"Neha N","family":"Goel","sequence":"first","affiliation":[{"name":"Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai , New York, NY,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7485-3741","authenticated-orcid":false,"given":"Bruno L","family":"Ferreyro","sequence":"additional","affiliation":[{"name":"Interdepartmental Division of Critical Care Medicine, Sinai Health System, University of Toronto , Toronto, ON,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3015-0723","authenticated-orcid":false,"given":"Tyler","family":"Pitre","sequence":"additional","affiliation":[{"name":"Division of Respirology, Department of Medicine, University Health Network, University of Toronto , Toronto, ON,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6610-3369","authenticated-orcid":false,"given":"Kimberley","family":"Lewis","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact, McMaster University , Hamilton, Ontario,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4581-2390","authenticated-orcid":false,"given":"Collin","family":"Homer-Bouthiette","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, Boston University School of Medicine , Boston, MA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0971-386X","authenticated-orcid":false,"given":"Federico","family":"Angriman","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Sunnybrook Health Sciences Centre , Toronto, ON,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0784-1331","authenticated-orcid":false,"given":"Leticia","family":"Kawano Dourado","sequence":"additional","affiliation":[{"name":"Hcor Research Institute, Hcor Hospital , Sao Paulo,","place":["Brazil"]},{"name":"Pulmonary Division, Hospital das Cl\u00ednicas\u2014HCFMUSP, University of S\u00e3o Paulo , S\u00e3o Paulo,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5476-0361","authenticated-orcid":false,"given":"Matthew G","family":"Drake","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University , Portland, OR,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0348-0527","authenticated-orcid":false,"given":"Tammy L","family":"Eaton","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hospital Medicine, Michigan Medicine , Ann Arbor, MI,","place":["United States"]},{"name":"VA Center for Clinical Management Research, VA Ann Arbor Healthcare System , Ann Arbor, MI,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheryl L","family":"Esbrook","sequence":"additional","affiliation":[{"name":"Department of Therapy Services, University of Chicago , Chicago, IL,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9176-7797","authenticated-orcid":false,"given":"Jean-Pierre","family":"Frat","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Intensive-R\u00e9animation, Centre Hospitalier Universitaire de Poitiers , Poitiers,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4557-6308","authenticated-orcid":false,"given":"Domenico L","family":"Grieco","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Catholic University of the Sacred Heart , Rome,","place":["Italy"]},{"name":"Department of Emergency, Intensive Care and Anesthesia, Fondazione Policlinico A. 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