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Weaning from Non-Invasive Mechanical Ventilation Approaches (NIV-NHF): Insights on How, When and Where

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Intensive Care".

Deadline for manuscript submissions: 25 November 2025 | Viewed by 918

Special Issue Editor

Special Issue Information

Dear Colleagues,

Weaning (withdrawal, escalation, or des-escalation steps) from non-invasive positive pressure ventilation (NIPPV) or nasal high flow oxygen relates to procedures that are put in place to obtain disconnection of the patient from non-invasive nasal high flow devices, and this is crucial in the achievement of best control in respiratory failure. Failure in any of these steps is associated with an increase in mortality and spending a long time in intensive care units or pneumology wards.

However, in terms of pathophysiology, determinant factors, the best tools for early diagnosis and prevention in weaning from NIV nasal high flow, are poorly defined in clinical practice.

In this proposed Special Issue, we aim to define the factors that have an impact on the steps of “how, when and where”, as well as the best escalation-de-escalation (weaning from NIV nasal high flow).

We are considering updating this topic to the following title: Weaning from Non-Invasive Mechanical Ventilation Approaches (NIV nasal high flow), focused on these key major issues:

  1. Withdrawal pathophysiology;
  2. Clinical determinants;
  3. Comorbid conditions;
  4. Equipment-ventilatory modes-setting;
  5. Special determinants in hypercapnic and hypoxemic;
  6. Escalation-de-escalation: determinants’ response;
  7. Recommendations for prevention, safe responses, and effectiveness;
  8. Summary and clinical evidence for withdrawal approach in three key questions: how, when, and where.

Dr. Antonio M. Esquinas
Guest Editor

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Keywords

  • non-invasive positive pressure ventilation (NIPPV)
  • nasal high flow oxygen
  • respiratory failure
  • intensive care units
  • pneumology wards
  • non-invasive mechanical ventilation approaches (NIV nasal high flow)

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Published Papers (1 paper)

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Review

21 pages, 854 KiB  
Review
Non-Invasive Ventilation: When, Where, How to Start, and How to Stop
by Mary Zimnoch, David Eldeiry, Oluwabunmi Aruleba, Jacob Schwartz, Michael Avaricio, Oki Ishikawa, Bushra Mina and Antonio Esquinas
J. Clin. Med. 2025, 14(14), 5033; https://doi.org/10.3390/jcm14145033 - 16 Jul 2025
Viewed by 268
Abstract
Non-invasive ventilation (NIV) is a cornerstone in the management of acute and chronic respiratory failure, offering critical support without the risks of intubation. However, successful weaning from NIV remains a complex, high-stakes process. Poorly timed or improperly executed weaning significantly increases morbidity and [...] Read more.
Non-invasive ventilation (NIV) is a cornerstone in the management of acute and chronic respiratory failure, offering critical support without the risks of intubation. However, successful weaning from NIV remains a complex, high-stakes process. Poorly timed or improperly executed weaning significantly increases morbidity and mortality, yet current clinical practice often relies on subjective judgment rather than evidence-based protocols. This manuscript reviews the current landscape of NIV weaning, emphasizing structured approaches, objective monitoring, and predictors of weaning success or failure. It examines guideline-based indications, monitoring strategies, and various weaning techniques—gradual and abrupt—with evidence of their efficacy across different patient populations. Predictive tools such as the Rapid Shallow Breathing Index, Lung Ultrasound Score, Diaphragm Thickening Fraction, ROX index, and HACOR score are analyzed for their diagnostic value. Additionally, this review underscores the importance of care setting—ICU, step-down unit, or general ward—and how it influences outcomes. Finally, it highlights critical gaps in research, especially around weaning in non-ICU environments. By consolidating current evidence and identifying predictors and pitfalls, this article aims to support clinicians in making safe, timely, and patient-specific NIV weaning decisions. In the current literature, there are gaps regarding patient selection and lack of universal protocolization for initiation and de-escalation of NIV as the data has been scattered. This review aims to consolidate the relevant information to be utilized by clinicians throughout multiple levels of care in all hospital systems. Full article
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