{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T21:14:46Z","timestamp":1774991686768,"version":"3.50.1"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T00:00:00Z","timestamp":1751932800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>The purpose of this study is to compare different non-invasive respiratory support methods for the treatment of acute hypercapnic respiratory failure (AHRF).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The network meta-analysis was conducted based on studies from PubMed, Embase, the Cochrane Library, and Web of Science, from their inception to September 10, 2024. The outcomes was treatment failure, all-cause mortality, intubation, dyspnea score, length of stay in hospital, respiratory rate, arterial carbon dioxide partial pressure (PaCO<jats:sub>2<\/jats:sub>), and complications. The results of both direct and indirect comparisons were quantitatively assessed using weighted mean differences or relative risks with their respective 95% confidence intervals, and graphically depicted in forest plots. Additionally, the rank probabilities were presented, demonstrating the likelihood of each non-invasive respiratory support method being the most effective across various measured outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Nineteen studies (2,022 participants) were included. The results indicated that the probability of treatment failure with face mask non-invasive ventilation (NIV) was lower than that of high-flow nasal cannula (HFNC) (RR: 1.42, 95% CI: 1.06, 1.93) and conventional oxygen treatment (COT) (RR: 1.87, 95% CI: 1.16, 3.03). Face mask NIV demonstrated superior performance in dyspnea score and PaCO<jats:sub>2<\/jats:sub> compared to HFNC, helmet NIV, and COT. The length of stay in the hospital for face mask NIV was relatively longer compared to HFNC (WMD: \u22120.73, 95% CI: \u22121.35, \u22120.10) and COT (WMD: \u22121.09, 95% CI: \u22122.00, \u22120.18), and the probability of complications was higher than with HFNC. The rank probability suggested that COT had the lowest likelihood of intubation and all-cause mortality, while helmet NIV may have the best effect on improving respiratory rate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Concerning treatment failure, dyspnea score, and PaCO<jats:sub>2<\/jats:sub> improvement in patients with AHRF, face mask NIV may outperform other methods. For selected patients with AHRF, face mask NIV might be considered for potential first-line method. This study provides a certain level of evidence-based support for the management and treatment of AHRF, but more research is still needed in the future to determine the optimal non-invasive respiratory support method for treating patients with AHRF. In clinic, the efficacy of face mask NIV for better outcomes in patients with AHRH still requires validation.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1594128","type":"journal-article","created":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T04:13:23Z","timestamp":1751948003000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["A comparative analysis of non-invasive respiratory support modalities in the treatment of acute hypercapnic respiratory failure: a network 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