High flow on the rise—pediatric perspectives on the FLORALI trial

Over the last decade, noninvasive positive pressure ventilation (NIV) has been increasingly used in adult and pediatric medicine to reduce the lung injuries, pneumonia, and denutrition associated with mechanical ventilation, which is implicated in the high mortality observed in these patients (1). For adults with acute exacerbations of chronic obstructive pulmonary disease (2) or severe cardiogenic pulmonary edema (3), it is now an evidence-based practice. It may also be an effective strategy in the perioperative period, provided that patients are carefully selected (4). The benefits of NIV have nevertheless not been clearly established in clinical situations like status asthmaticus (5) or acute hypoxemic respiratory failure (AHRF) or as a means to facilitate earlier extubation (6). The conflicting results for ARHF may be due to its several etiologies, which has prompted new trials with less heterogeneous patient groups (7).