ATS guideline: high-flow for hypoxaemic failure, NIV for hypercapnic

The edition in brief

The American Thoracic Society's GRADE-based guideline on noninvasive respiratory support makes a strong recommendation for high-flow nasal cannula and a conditional one for NIV or CPAP in acute hypoxaemic respiratory failure, a strong recommendation for NIV in hypercapnic failure to reduce death and intubation, and allows high-flow only in milder hypercapnia with pH above about 7.25 and ready escalation. High-flow or NIV is strongly recommended for preoxygenation, and after extubation high-flow for low-risk and NIV for high-risk patients. A European SHARP registry analysis of 3876 adults with severe asthma found current and former smokers improved on biologics by a similar magnitude to never-smokers, although 29% of countries reported opposition to prescribing to smokers. A pooled analysis of ALIENTO and ARNASA (2682 participants) found astegolimab every two weeks cut moderate or severe COPD exacerbations by 15% (rate ratio 0.85). A single-centre Chinese trial in 68 patients with IPF found gabapentin up to 900 mg a day relieved cough in 73.5% versus 26.5% on placebo, with more drowsiness and dizziness.