# Bridging the Gap: The Role of Non-Invasive Respiratory Supports in Weaning from Invasive Mechanical Ventilation

## TL;DR

This paper reviews how non-invasive respiratory supports like NIV and HFNCs can help patients transition from mechanical ventilation to breathing on their own, improving outcomes.

## Contribution

The paper provides a comprehensive review of the role and effectiveness of non-invasive respiratory supports in weaning from invasive mechanical ventilation.

## Key findings

- Non-invasive ventilation (NIV) and high-flow nasal cannulas (HFNCs) are effective in preventing post-extubation respiratory failure in high-risk and low-risk patients.
- NIV is not recommended for non-hypercapnic post-extubation respiratory failure due to potential increased mortality.
- Appropriate use of non-invasive respiratory supports can improve outcomes in critically ill patients at risk of post-operative pulmonary complications.

## Abstract

Weaning from invasive mechanical ventilation (IMV) is a key element in the management of critically ill patients, encompassing the entire process of discontinuing IMV. Despite its importance, considerable uncertainties remain regarding the optimal strategies to achieve successful weaning. Early weaning is crucial, as IMV is associated with complications related to high mortality rates, such as prolonged weaning and intubation-associated pneumonia (IAP). This review aims to highlight the role of non-invasive respiratory supports (NIRSs), including non-invasive ventilation (NIV) and high-flow nasal cannulas (HFNCs), as a therapeutic bridge between IMV dependency and spontaneous breathing. NIV and HFNCs are recommended to prevent post-extubation respiratory failure (PERF) in high-risk and low-risk patients, respectively, and their combination appears effective in high-risk populations. On the other hand, NIV is not advised in established non-hypercapnic PERF, as it may increase mortality by delaying intubation; however, it can facilitate extubation in patients with hypercapnic respiratory failure. NIRSs may also benefit patients at high risk of post-operative pulmonary complications such as acute respiratory failure (ARF), with either NIV or HFNCs being appropriate. In light of this evidence, appropriate NIRSs selection and application may be pivotal in achieving successful weaning and better outcomes in critically ill patients.