Titrating and Discontinuing Noninvasive Respiratory Support in the Emergency Department.

Acute respiratory failure is common in the emergency department (ED), often requiring noninvasive respiratory support (NIRS). NIRS has become a cornerstone in the initial management of acute respiratory failure. Despite its growing use, significant variability in practice remains, and evidence-based guidance specific to the ED setting is limited. This article aims to provide emergency physicians with a practical, evidence-informed framework for initiating and managing NIRS in adults with acute respiratory failure, with a focus on initial settings, titration, monitoring for failure, and guidance on weaning and liberation.