{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T05:09:13Z","timestamp":1778562553055,"version":"3.51.4"},"reference-count":72,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Non-invasive respiratory support (NRS) has become a cornerstone in the management of acute respiratory failure (ARF), offering an alternative or a bridge between conventional oxygen therapy (COT) and invasive mechanical ventilation (iMV). While NRS techniques\u2014including non-invasive ventilation (NIV), continuous positive airway pressure (CPAP), and high-flow nasal oxygen (HFNO)\u2014have demonstrated efficacy in reducing intubation rates and improving outcomes, patient tolerance and synchrony remain critical determinants of success. Analgosedation, the strategic use of analgesics and sedatives, has emerged as an important adjunctive therapy to optimise NRS delivery, reduce patient\u2013ventilator asynchrony, and improve comfort. However, the delicate balance between adequate sedation and the preservation of spontaneous breathing, airway protection, and hemodynamic stability presents unique challenges. This comprehensive narrative review synthesises current evidence on analgosedation strategies during NRS use, examining pharmacological agents, their pharmacokinetic and pharmacodynamic properties, comparative studies, indications, monitoring parameters, clinical settings, and safety considerations. We also review existing guidelines, discuss special considerations in paediatric populations, and propose practical clinical approaches. Understanding the nuanced application of analgosedation is essential for clinicians to maximise therapeutic benefit while minimising risks of NRS treatment failure and adverse outcomes.<\/jats:p>","DOI":"10.3390\/jcm15093418","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T15:01:18Z","timestamp":1777474878000},"page":"3418","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Analgosedation During the Use of Non-Invasive Respiratory Supports: A Synthesis of Clinical Evidence and Best Practices"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0560-786X","authenticated-orcid":false,"given":"Giovanni","family":"Misseri","sequence":"first","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Fondazione Istituto \u201cG.Giglio\u201d Cefal\u00f9, 90015 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2156-0088","authenticated-orcid":false,"given":"Matteo","family":"Piattoli","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Umberto I Policlinico di Roma, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alice","family":"Mirasola","sequence":"additional","affiliation":[{"name":"Saint Camillus International University of Health and Medical Sciences \u201cUniCamillus\u201d, 00131 Rome, Italy"},{"name":"Department of Anaesthesia, San Giovanni di Dio Hospital, 92100 Agrigento, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cesare","family":"Gregoretti","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Fondazione Istituto \u201cG.Giglio\u201d Cefal\u00f9, 90015 Palermo, Italy"},{"name":"Saint Camillus International University of Health and Medical Sciences \u201cUniCamillus\u201d, 00131 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Misseri, G., Frassanito, L., Simonte, R., Ros\u00e0, T., Grieco, D.L., Piersanti, A., De Robertis, E., and Gregoretti, C. (2023). Personalized Noninvasive Respiratory Support in the Perioperative Setting: State of the Art and Future Perspectives. J. Pers. Med., 14.","DOI":"10.3390\/jpm14010056"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1969","DOI":"10.1007\/s00134-011-2375-1","article-title":"Fiberoptic bronchoscopy under noninvasive ventilation and propofol target-controlled infusion in hypoxemic patients","volume":"37","author":"Clouzeau","year":"2011","journal-title":"Intensive Care Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2298","DOI":"10.1097\/01.CCM.0000284512.21942.F8","article-title":"Survey of sedation practices during noninvasive positive-pressure ventilation to treat acute respiratory failure","volume":"35","author":"Devlin","year":"2007","journal-title":"Crit. Care Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/S0140-6736(09)60496-7","article-title":"Non-invasive ventilation in acute respiratory failure","volume":"374","author":"Nava","year":"2009","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1164\/ajrccm.163.2.9906116","article-title":"Noninvasive ventilation","volume":"163","author":"Mehta","year":"2001","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2299","DOI":"10.2169\/internalmedicine.51.7810","article-title":"Dexmedetomidine versus midazolam for the sedation of patients with non-invasive ventilation failure","volume":"51","author":"Huang","year":"2012","journal-title":"Intern. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1007\/s00134-006-0447-4","article-title":"Remifentanil-based sedation to treat noninvasive ventilation failure: A preliminary study","volume":"33","author":"Constantin","year":"2007","journal-title":"Intensive Care Med."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Cammarota, G., Simonte, R., and De Robertis, E. (2022). Comfort During Non-invasive Ventilation. Front. Med., 9, Erratum in Front. Med. 2023, 10, 1193466. https:\/\/doi.org\/10.3389\/fmed.2023.1193466.","DOI":"10.3389\/fmed.2023.1193466"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"155080","DOI":"10.1016\/j.jcrc.2025.155080","article-title":"Analgosedation practice during noninvasive respiratory supports: Results from an Italian survey","volume":"88","author":"Spinazzola","year":"2025","journal-title":"J. Crit. Care"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1186\/2049-6958-9-56","article-title":"Sedation in non-invasive ventilation: Do we know what to do (and why)?","volume":"9","author":"Longrois","year":"2014","journal-title":"Multidiscip. Respir. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1586","DOI":"10.1007\/s00134-015-3854-6","article-title":"Impact of sedation and analgesia during noninvasive positive pressure ventilation on outcome: A marginal structural model causal analysis","volume":"41","author":"Muriel","year":"2015","journal-title":"Intensive Care Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1007\/s00134-005-0050-0","article-title":"Time of non-invasive ventilation","volume":"32","author":"Nava","year":"2006","journal-title":"Intensive Care Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1007\/s00134-012-2475-6","article-title":"Non-invasive ventilation in community-acquired pneumonia and severe acute respiratory failure","volume":"38","author":"Carrillo","year":"2012","journal-title":"Intensive Care Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1164\/rccm.201606-1306OC","article-title":"Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome. Insights from the LUNG SAFE Study","volume":"195","author":"Bellani","year":"2017","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.1378\/chest.128.3.1657","article-title":"Noninvasive positive pressure ventilation in patients with acute exacerbations of COPD and varying levels of consciousness","volume":"128","author":"Scala","year":"2005","journal-title":"Chest"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1718","DOI":"10.1007\/s00134-001-1114-4","article-title":"Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: A multi-center study","volume":"27","author":"Antonelli","year":"2001","journal-title":"Intensive Care Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1097\/CCM.0000000000001379","article-title":"Failure of noninvasive ventilation for de novo acute hypoxemic respiratory failure: Role of tidal volume","volume":"44","author":"Carteaux","year":"2016","journal-title":"Crit. Care Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1097\/CCM.0b013e3181928706","article-title":"Interface strategy during noninvasive positive pressure ventilation for hypercapnic acute respiratory failure","volume":"37","author":"Girault","year":"2009","journal-title":"Crit. Care Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.1007\/s00134-006-0301-8","article-title":"Patient-ventilator asynchrony during assisted mechanical ventilation","volume":"32","author":"Thille","year":"2006","journal-title":"Intensive Care Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e1282","DOI":"10.1097\/CCM.0000000000006664","article-title":"Dyspnea Among Mechanically Ventilated Patients: A Systematic Review","volume":"53","author":"Grush","year":"2025","journal-title":"Crit. Care Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1164\/rccm.202108-1857OC","article-title":"Prevalence, Intensity, and Clinical Impact of Dyspnea in Critically Ill Patients Receiving Invasive Ventilation","volume":"205","author":"Demoule","year":"2022","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"295","DOI":"10.4187\/respcare.04490295","article-title":"Causes of failure of noninvasive mechanical ventilation","volume":"49","author":"Nava","year":"2004","journal-title":"Respir. Care"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1097\/01.CCM.0000260055.64235.7C","article-title":"Patient-ventilator interaction and sleep in mechanically ventilated patients: Pressure support versus proportional assist ventilation","volume":"35","author":"Bosma","year":"2007","journal-title":"Crit. Care Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1007\/s00134-016-4601-3","article-title":"Assessment of heart rate, acidosis, consciousness, oxygenation, and respiratory rate to predict noninvasive ventilation failure in hypoxemic patients","volume":"43","author":"Duan","year":"2017","journal-title":"Intensive Care Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.jcrc.2016.05.022","article-title":"Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: The utility of the ROX index","volume":"35","author":"Roca","year":"2016","journal-title":"J. Crit. Care"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1007\/s40265-015-0419-5","article-title":"Dexmedetomidine: A review of its use for sedation in the intensive care setting","volume":"75","author":"Keating","year":"2015","journal-title":"Drugs"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"263","DOI":"10.2165\/00003495-200059020-00012","article-title":"Dexmedetomidine","volume":"59","author":"Bhana","year":"2000","journal-title":"Drugs"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.arcmed.2020.11.001","article-title":"Dexmedetomidine attenuates lung injury in toxic shock rats by inhibiting inflammation and autophagy","volume":"52","author":"Li","year":"2021","journal-title":"Arch. Med. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.resp.2017.06.007","article-title":"Remifentanil effects on respiratory drive and timing during pressure support ventilation and neurally adjusted ventilatory assist","volume":"244","author":"Costa","year":"2017","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2060","DOI":"10.1007\/s00134-010-2026-y","article-title":"Rescue treatment for noninvasive ventilation failure due to interface intolerance with remifentanil analgosedation: A pilot study","volume":"36","author":"Rocco","year":"2010","journal-title":"Intensive Care Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"827","DOI":"10.4187\/respcare.01014","article-title":"Remifentanil improves breathing pattern and reduces inspiratory workload in tachypneic patients","volume":"56","author":"Natalini","year":"2011","journal-title":"Respir. Care"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1007\/s00134-023-07246-x","article-title":"Dyspnoea in acutely ill mechanically ventilated adult patients: An ERS\/ESICM statement","volume":"50","author":"Demoule","year":"2024","journal-title":"Intensive Care Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1675","DOI":"10.1007\/s00134-010-1904-7","article-title":"Target-controlled infusion of propofol for sedation in patients with non-invasive ventilation failure due to low tolerance: A preliminary study","volume":"36","author":"Clouzeau","year":"2010","journal-title":"Intensive Care Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1097\/CCM.0b013e31829e53dc","article-title":"Effects of propofol on patient ventilator synchrony and interaction during pressure support ventilation and neurally adjusted ventilatory assist*","volume":"42","author":"Vaschetto","year":"2014","journal-title":"Crit. Care Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1007\/s10916-025-02187-y","article-title":"Target-Controlled Infusion of Propofol: A Systematic Review of Recent Results","volume":"49","author":"Bruthans","year":"2025","journal-title":"J. Med. Syst."},{"key":"ref_36","first-page":"812","article-title":"Continuous intravenous infusion of ketamine for maintenance sedation","volume":"77","author":"Miller","year":"2011","journal-title":"Minerva Anestesiol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Misseri, G., Piattoli, M., Mirasola, A., Guarrera, L., Evangelista, C., Cuttone, G., La Via, L., and Gregoretti, C. (2026). Strategies for a Ra-tional Use of Opioids in Critical Care Settings. J. Clin. Med., 15.","DOI":"10.3390\/jcm15031039"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e825","DOI":"10.1097\/CCM.0000000000003299","article-title":"Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation\/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU","volume":"46","author":"Devlin","year":"2018","journal-title":"Crit. Care Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"635737","DOI":"10.1155\/2015\/635737","article-title":"Defining the Role of Dexmedetomidine in the Prevention of Delirium in the Intensive Care Unit","volume":"2015","author":"Nelson","year":"2015","journal-title":"BioMed Res. Int."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.curtheres.2010.06.003","article-title":"Sedation during noninvasive mechanical ventilation with dexmedetomidine or midazolam: A randomized, double-blind, prospective study","volume":"71","author":"Senoglu","year":"2010","journal-title":"Curr. Ther. Res. Clin. Exp."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Alt\u0131nkaya \u00c7avu\u015f, M., G\u00f6kbulut Bekta\u015f, S., and Turan, S. (2022). Comparison of clinical safety and efficacy of dexmedetomidine, remifentanil, and propofol in patients who cannot tolerate non-invasive mechanical ventilation: A prospective, randomized, cohort study. Front. Med., 9.","DOI":"10.3389\/fmed.2022.995799"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1378\/chest.13-1448","article-title":"Efficacy and safety of early dexmedetomidine during noninvasive ventilation for patients with acute respiratory failure: A randomized, double-blind, placebo-controlled pilot study","volume":"145","author":"Devlin","year":"2014","journal-title":"Chest"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2274","DOI":"10.1016\/j.chest.2020.12.052","article-title":"Safety and Efficacy of Dexmedetomidine in Acutely Ill Adults Requiring Noninvasive Ventilation: A Systematic Review and Meta-analysis of Randomized Trials","volume":"159","author":"Lewis","year":"2021","journal-title":"Chest"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.hrtlng.2023.09.005","article-title":"Sedation and analgesia strategies for non- invasive mechanical ventilation: A systematic review and meta-analysis","volume":"63","author":"Yang","year":"2024","journal-title":"Heart Lung"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1097\/CCM.0000000000006253","article-title":"Analgesia and Sedation Use During Noninvasive Ventilation for Acute Respiratory Failure","volume":"52","author":"Dunbar","year":"2024","journal-title":"Crit. Care Med."},{"key":"ref_46","first-page":"477","article-title":"Dexmedetomidine to facilitate non-invasive ventilation after blunt chest trauma: A randomised, double-blind, crossover, placebo-controlled pilot study","volume":"38","author":"Deletombe","year":"2019","journal-title":"Anaesth. Crit. Care Pain Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/s40560-024-00750-2","article-title":"Remifentanil vs. dexmedetomidine for cardiac surgery patients with noninvasive ventilation intolerance: A multicenter randomized controlled trial","volume":"12","author":"Hao","year":"2024","journal-title":"J. Intensive Care"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1016\/S2213-2600(18)30388-6","article-title":"Beyond the guidelines for non-invasive ventilation in acute respiratory failure: Implications for practice","volume":"6","author":"Bourke","year":"2018","journal-title":"Lancet Respir. Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1186\/s13063-023-07560-1","article-title":"A pragmatic, open-label, multi-center, randomized controlled clinical trial on the rotational use of interfaces vs standard of care in patients treated with noninvasive positive pressure ventilation for acute hypercapnic respiratory failure: The ROTAtional-USE of interface STUDY (ROTA-USE STUDY)","volume":"24","author":"Vaschetto","year":"2023","journal-title":"Trials"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1177\/19433654251376992","article-title":"Asynchrony: Clinical Relevance, Detection, and Resolution","volume":"70","author":"Telias","year":"2025","journal-title":"Respir. Care"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"S9","DOI":"10.1016\/j.pulmoe.2021.06.012","article-title":"Effectiveness and safety of a new helmet CPAP configuration allowing tidal volume monitoring in patients with COVID-19","volume":"29","author":"Chiappero","year":"2023","journal-title":"Pulmonology"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.pulmoe.2022.12.006","article-title":"Early pronation, protective lung ventilation and use of awake-prone-HFNO therapy after extubation in near-fatal drowning","volume":"30","author":"Misseri","year":"2024","journal-title":"Pulmonology"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.hrtlng.2014.12.002","article-title":"Efficacy of noninvasive ventilation after planned extubation: A systematic review and meta-analysis of randomized controlled trials","volume":"44","author":"Bajaj","year":"2015","journal-title":"Heart Lung"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1186\/s44158-024-00203-0","article-title":"Management of analgosedation during noninvasive respiratory support: An expert Delphi consensus document developed by the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI)","volume":"4","author":"Spinazzola","year":"2024","journal-title":"J. Anesth. Analg. Crit. Care"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Matsumoto, T., Tomii, K., Tachikawa, R., Otsuka, K., Nagata, K., Otsuka, K., Nakagawa, A., Mishima, M., and Chin, K. (2015). Role of sedation for agitated patients undergoing noninvasive ventilation: Clinical practice in a tertiary referral hospital. BMC Pulm. Med., 15.","DOI":"10.1186\/s12890-015-0072-5"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1164\/rccm.2107138","article-title":"The Richmond Agitation-Sedation Scale: Validity and reliability in adult intensive care unit patients","volume":"166","author":"Sessler","year":"2002","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1097\/00003246-199907000-00022","article-title":"Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients","volume":"27","author":"Riker","year":"1999","journal-title":"Crit. Care Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1186\/s13054-021-03697-0","article-title":"Noninvasive respiratory support outside the intensive care unit for acute respiratory failure related to coronavirus-19 disease: A systematic review and meta-analysis","volume":"25","author":"Cammarota","year":"2021","journal-title":"Crit. Care"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e0018","DOI":"10.1097\/EA9.0000000000000018","article-title":"\u2018Do-not-intubate\u2019 orders in patients assisted by noninvasive respiratory support for acute hypoxaemic failure caused by coronavirus disease 2019; a systematic review and meta-analysis","volume":"2","author":"Cammarota","year":"2023","journal-title":"Eur. J. Anaesthesiol. Intensive Care"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.5811\/westjem.2021.4.50917","article-title":"The Use of Dexmedetomidine in the Emergency Department: A Cohort Study","volume":"22","author":"Sinnott","year":"2021","journal-title":"West. J. Emerg. Med."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1602426","DOI":"10.1183\/13993003.02426-2016","article-title":"Official ERS\/ATS clinical practice guidelines: Noninvasive ventilation for acute respiratory failure","volume":"50","author":"Rochwerg","year":"2017","journal-title":"Eur. Respir. J."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"ii1","DOI":"10.1136\/thoraxjnl-2015-208209","article-title":"BTS\/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults","volume":"71","author":"Davidson","year":"2016","journal-title":"Thorax"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1186\/s13054-025-05730-y","article-title":"A clinical guide to non-invasive respiratory support in acute respiratory failure: Ventilation settings, technical optimization and clinical indications","volume":"29","author":"Rezoagli","year":"2025","journal-title":"Crit. Care"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1510","DOI":"10.1007\/s00134-011-2308-z","article-title":"The number of failing organs predicts non-invasive ventilation failure in children with ALI\/ARDS","volume":"37","author":"Piastra","year":"2011","journal-title":"Intensive Care Med."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"301","DOI":"10.4187\/respcare.09360","article-title":"Dexmedetomidine for Sedation During Pediatric Noninvasive Ventilation","volume":"67","author":"Eidman","year":"2022","journal-title":"Respir. Care"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1097\/PCC.0000000000001226","article-title":"Dexmedetomidine for Sedation During Noninvasive Ventilation in Pediatric Patients","volume":"18","author":"Venkatraman","year":"2017","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1097\/PCC.0000000000001451","article-title":"Dexmedetomidine as Single Continuous Sedative During Noninvasive Ventilation: Typical Usage, Hemodynamic Effects, and Withdrawal","volume":"19","author":"Shutes","year":"2018","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1177\/1060028017734560","article-title":"Dexmedetomidine Use in a Pediatric Intensive Care Unit: A Retrospective Cohort Study","volume":"52","author":"Banasch","year":"2018","journal-title":"Ann. Pharmacother."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1186\/s12887-018-1256-y","article-title":"Dexmedetomidine is effective and safe during NIV in infants and young children with acute respiratory failure","volume":"18","author":"Piastra","year":"2018","journal-title":"BMC Pediatr."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1093\/jpepsy\/17.1.95","article-title":"Assessing distress in pediatric intensive care environments: The COMFORT scale","volume":"17","author":"Ambuel","year":"1992","journal-title":"J. Pediatr. Psychol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1097\/01.PCC.0000200955.40962.38","article-title":"State Behavioral Scale: A sedation assessment instrument for infants and young children supported on mechanical ventilation","volume":"7","author":"Curley","year":"2006","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"938","DOI":"10.5005\/jp-journals-10071-23950","article-title":"Role of Sedation and Analgesia during Noninvasive Ventilation: Systematic Review of Recent Evidence and Recommendations","volume":"26","author":"Karim","year":"2022","journal-title":"Indian J. Crit. 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