Schematic Assessment of Non-invasive Ventilation in Acute Respiratory Failure by Exploration of Paradigm Shift in Emergency Medicine.

Non-invasive ventilation (NIV) has gained attention as an important intervention for the treatment of acute respiratory failure (ARF) in both resource-constrained and non-intensive care unit (ICU) settings. Clinical outcomes and the efficacy and failure indicators of NIV treatment are still inconsistent across a wide range of research studies. This systematic review and meta-analysis evaluated the efficacy of NIV in ARF by looking at treatment site effects, failure predictor variables, together with aggregated outcomes. Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines, this study looked for pertinent research studies from 2000 to 2025 by employing PubMed, Scopus, Embase, and Cochrane Library databases. Adult patients who met the inclusion criteria received NIV treatment for ARF. The random-effects method calculated odds ratio pools (ORs) for outcome achievement and non-achievement across the studies. Standardized instruments that relied on the features of the study design were used to assess the risk of bias. Eleven studies (n=20,312) were included. The pooled OR for improved outcomes with NIV was 2.01 (95% CI: 1.66-2.43). Success rates ranged from 55.6% to 72.1% with common failure predictors including elevated respiratory rate, CO₂ levels, D-dimer as well as clinical indices such as respiratory rate-oxygenation (ROX) and heart rate, acidosis, consciousness, oxygenation, and respiratory rate (HACOR) scores. NIV was effective in both ICU and general ward settings. NIV significantly improved the outcomes in ARF that offered a viable strategy in various settings. Early identification of respiratory failure by using the validated clinical tools was essential. These findings supported broader application of NIV in clinical practice.