Non-invasive respiratory support therapies in the acute setting: how to improve the success rate of weaning

ABSTRACT
Noninvasive respiratory support modalities such as noninvasive ventilation (NIV), continuous positive airway pressure (CPAP), and high-flow nasal cannula (HFNC) are commonly used in children with various acute respiratory conditions, characterized by oxygen dependence, hypercapnia, or both. The primary goals of noninvasive support in these patients are to reverse moderate respiratory failure while
avoiding therapeutic escalation such as intubation and invasive ventilation, or to stabilize the clinical condition of a previously invasively ventilated patient to prevent extubation failure. Despite the strategic role of noninvasive respiratory support to reduce the impact of invasive mechanical ventilation, which requires admission in intensive care unit and exposes patients to higher risk of ventilator-associated complications, currently available evidence is not sufficient to establish solid guidelines or standardized protocols on initiation criteria, operating procedures, weaning strategies, and failure criteria, as well as to define the most appropriate settings in which to deliver noninvasive respiratory support. Further studies are needed to determine where and how to implement noninvasive respiratory support and which weaning strategies might provide the best outcomes in pediatric patients with acute respiratory failure.

IMPACT STATEMENT
Effective weaning from noninvasive respiratory support is essential.

Received: Sept 02, 2025
Accepted: Jan 29, 2026
Published: Apr 02, 2026