Non-invasive ventilation in COVID-19-related acute hypoxemic respiratory failure: a narrative review

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 ventil...

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Main Authors: Luigi Aronne, Raffaella Pagliaro, Angela Schiattarella, Susan FM Campbell, Maria Vitale, Fabio Perrotta, Klara Komici, Germano Guerra, Andrea Bianco, Filippo Scialò, Vanvitelli - Monaldi COVID Group
Format: Article
Language:English
Published: PAGEPress Publications 2025-07-01
Series:Monaldi Archives for Chest Disease
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Online Access:https://www.monaldi-archives.org/macd/article/view/3432
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author Luigi Aronne
Raffaella Pagliaro
Angela Schiattarella
Susan FM Campbell
Maria Vitale
Fabio Perrotta
Klara Komici
Germano Guerra
Andrea Bianco
Filippo Scialò
Vanvitelli - Monaldi COVID Group
author_facet Luigi Aronne
Raffaella Pagliaro
Angela Schiattarella
Susan FM Campbell
Maria Vitale
Fabio Perrotta
Klara Komici
Germano Guerra
Andrea Bianco
Filippo Scialò
Vanvitelli - Monaldi COVID Group
author_sort Luigi Aronne
collection DOAJ
description 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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spelling doaj-art-78e6a61d60b14c45a127db167616e22f2025-08-20T03:56:04ZengPAGEPress PublicationsMonaldi Archives for Chest Disease1122-06432532-52642025-07-0110.4081/monaldi.2025.3432Non-invasive ventilation in COVID-19-related acute hypoxemic respiratory failure: a narrative reviewLuigi Aronne0Raffaella Pagliaro1Angela Schiattarella2Susan FM Campbell3Maria Vitale4Fabio Perrotta5Klara Komici6Germano Guerra7Andrea Bianco8Filippo Scialò9Vanvitelli - Monaldi COVID Group10Department of Medical Translational Science, University of Campania "L. Vanvitelli", Naples; Pneumology Unit Vanvitelli A.O., Colli Monaldi Hospital, NaplesDepartment of Medical Translational Science, University of Campania "L. Vanvitelli", Naples; Pneumology Unit Vanvitelli A.O., Colli Monaldi Hospital, NaplesDepartment of Medical Translational Science, University of Campania "L. Vanvitelli", Naples; Pneumology Unit Vanvitelli A.O., Colli Monaldi Hospital, NaplesDepartment of Medical Translational Science, University of Campania "L. Vanvitelli", Naples; Pneumology Unit Vanvitelli A.O., Colli Monaldi Hospital, NaplesCEINGE-Biotecnologie Avanzate-Franco Salvatore, NaplesDepartment of Medical Translational Science, University of Campania "L. Vanvitelli", Naples; Pneumology Unit Vanvitelli A.O., Colli Monaldi Hospital, NaplesDepartment of Medicine and Health Sciences, University of Molise, CampobassoDepartment of Medicine and Health Sciences, University of Molise, CampobassoDepartment of Medical Translational Science, University of Campania "L. Vanvitelli", Naples; Pneumology Unit Vanvitelli A.O., Colli Monaldi Hospital, NaplesDepartment of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, NaplesGiulia Alaimo, Valentino Allocca, Lidia Atripaldi, Luca Borgese, Cecilia Calabrese, Nicola Carro, Donatella Cennamo, Francesco Saverio Cerqua, Roberta Cianci, Stefano Conte, Adriano Costigliola, Ilaria Di Fiore, Antonio D’Orologio, Ramona Fomez, Edoardo Grella, Serena Sardi, Carlo Iadevaia, Giuseppe Luciano, Dalila Manna, Umberto Masi, Grazia Mazzeo, Domenica Francesca Mariniello, Paola Medusa, Ersilia Nigro, Ilaria Palma, Antonio Ricci, Michela Ruotolo, Alessia Sola, Vittoria Ugliano 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 https://www.monaldi-archives.org/macd/article/view/3432COVID-19respiratory functionnon-invasive ventilation
spellingShingle Luigi Aronne
Raffaella Pagliaro
Angela Schiattarella
Susan FM Campbell
Maria Vitale
Fabio Perrotta
Klara Komici
Germano Guerra
Andrea Bianco
Filippo Scialò
Vanvitelli - Monaldi COVID Group
Non-invasive ventilation in COVID-19-related acute hypoxemic respiratory failure: a narrative review
Monaldi Archives for Chest Disease
COVID-19
respiratory function
non-invasive ventilation
title Non-invasive ventilation in COVID-19-related acute hypoxemic respiratory failure: a narrative review
title_full Non-invasive ventilation in COVID-19-related acute hypoxemic respiratory failure: a narrative review
title_fullStr Non-invasive ventilation in COVID-19-related acute hypoxemic respiratory failure: a narrative review
title_full_unstemmed Non-invasive ventilation in COVID-19-related acute hypoxemic respiratory failure: a narrative review
title_short Non-invasive ventilation in COVID-19-related acute hypoxemic respiratory failure: a narrative review
title_sort non invasive ventilation in covid 19 related acute hypoxemic respiratory failure a narrative review
topic COVID-19
respiratory function
non-invasive ventilation
url https://www.monaldi-archives.org/macd/article/view/3432
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