Pneumology - Reviews
23 July 2025
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Non-invasive ventilation in COVID-19-related acute hypoxemic respiratory failure: a narrative review
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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The high mortality rate and extended ventilator use associated with invasive mechanical ventilation in patients with severe COVID-19 have sparked a debate about the use of non-invasive respiratory support, such as high-flow nasal cannula, continuous positive airway pressure, and non-invasive ventilation (NIV), as treatment options. According to the European Respiratory Society and the American Thoracic Society clinical practice guidelines, NIV is recommended to prevent intubation in hypoxemic acute respiratory failure in patients with community-acquired pneumonia or early acute respiratory distress syndrome without major organ dysfunction. Central to this debate is the role of NIV in managing acute hypoxemic respiratory failure. However, there are concerns that NIV might delay the timely intubation and lung-protective ventilation in patients with more advanced disease, potentially worsening respiratory parameters due to self-inflicted lung injury. This review aims to explore the current literature, focusing on the rationale, patient selection, and outcomes associated with the use of NIV in COVID-19 patients with acute respiratory failure, to better understand its role in this context.
Vanvitelli - Monaldi COVID Group: Giulia Alaimo,1 Valentino Allocca,1 Lidia Atripaldi,1,2 Luca Borgese,1,2 Cecilia Calabrese,1,2 Nicola Carro,1 Donatella Cennamo,1,2 Francesco Saverio Cerqua,2 Roberta Cianci,2 Stefano Conte,1,2 Adriano Costigliola,2 Ilaria Di Fiore,1,2 Antonio D’Orologio,1,2 Ramona Fomez,1,2 Edoardo Grella,1 Serena Sardi,1 Carlo Iadevaia,1,2 Giuseppe Luciano,1 Dalila Manna,1,2 Umberto Masi,1,2 Grazia Mazzeo,2 Domenica Francesca Mariniello,1,2 Paola Medusa,1 Ersilia Nigro,3 Ilaria Palma,1 Antonio Ricci,1 Michela Ruotolo,1,2 Alessia Sola,1,2 Vittoria Ugliano1,2
1Department of Medical Translational Science, University of Campania "L. Vanvitelli", Naples; 2Pneumology Unit Vanvitelli A.O., Colli Monaldi Hospital, Naples; 3CEINGE-Biotecnologie Avanzate-Franco Salvatore, Naples, Italy
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“Non-Invasive Ventilation in COVID-19-Related Acute Hypoxemic Respiratory Failure: A Narrative Review”. 2025. Monaldi Archives for Chest Disease, July. https://doi.org/10.4081/monaldi.2025.3432.
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