Table 2 Future insights for the future of NIV reported by the experts

1

• “A good, well-designed, large randomized controlled trial of NIV vs. oxygen in acute de novo hypoxemic respiratory failure, not specifically designed for immunocompromised patients”

• “The perfect interface”

• “Reliable early predictors of NIV failure”

2

• “Randomized controlled trial of HFNT + NIV vs continuous NIV vs HFNT in hypoxemic respiratory failure”

3

• “Comparison of HFNT vs NIV in acute hypoxemic respiratory failure, performed according to the usual practice (in the Frat’s paper NIV was not really the clinical practice)”

4

• “The most important insight for the future is the development of HFNT in conjunction and not as an absolute replacement for NIV”

5

• “New inclusion criteria: better definition of patients clinical characteristics to be assisted by NIPPV/CPAP, timing of treatment initiation and interruption”

• “New devices: new masks and interfaces more adaptable to patients”

• “New comparisons: NIV vs invasive ventilation is hypoxemic respiratory failure and severe COPD. Most of studies have compared NIV with oxygen delivered by a Venturi systems!”

• “New modalities of monitoring: development of accurate and precise non invasive CO₂ monitoring as well as inspiratory efforts during NIV. Development of accurate and precise non invasive monitoring of lung morphological changes during NIV (for example quantitative sonography)”

6

• “Early treatment of acute hypercapnic respiratory failure and hypoxemic respiratory failure, even outside the ICU.

• “Mild to moderate hypoxemia in patients who do not improve with HFNT”

• “Patients with acute respiratory failure and do-not intubate orders”

7

• “We will see some reduction in use of NIV as HFNT makes inroads into the use of NIV for hypoxemic respiratory failure and perhaps somewhat for hypercapnic respiratory failure (at least in milder cases)”

• “Extracorporeal CO₂ removal will be used instead of NIV in hypercapnic patients at high risk of NIV failure”

8

“The most important insight for the future of NIV will be the development of innovative characteristics of interfaces material, able to improve patient’s comfort and biocompatibility”

10

• “A software-based setting of NIV adjusted according to flow/pressure curves and SpO₂ to achieve the best PS/PEEP levels and FiO2”

11

• “The most important insight for the future is to succeed in developing a new trigger system able to capture and correct autocycling and wasted effort in a fully noninvasive way, despite the presence of moderate or high air leaks”

12

• “When we evaluate outcomes, we should consider them not only as a result of a binary option of intervention (NIV or no-NIV) but rather as a function of the time spent under each of available interventions (e.g. O2, HFNT, CPAP, IMV)

• “We also need to stratify patients according to the underlying pulmonary disease/condition”

• “To replicate Antonelli et al. [36] study in other immunocompromized patients population”