RENOVATE Fibrosis:HFNC Versus NIPPV in Acute Respiratory Failure in Patients With Pulmonary Fibrosis

Inclusion Criteria: Sequential adult patients 18 years of age or older admitted to the hospital with pulmonary fibrosis and acute onset of respiratory failure that meets criteria A and B bellow. A. Pulmonary fibrosis will be defined by all of the criteria below: * presence of Velcro-type crackles on physical examination * imaging compatible with pulmonary fibrosis * diffuse disease on imaging B. Acute respiratory failure (ARF) will be defined by hypoxemia evidenced by SpO2 \<90% or PaO2 \<60 mmHg in room air and at least two of the criteria below within the last four weeks: * worsening dyspnea * worsening breathing effort * worsening gas exchange (worsening SpO2 or paO2) * worsening respiratory rate, above 25 irpm Exclusion Criteria: * Pulmonary fibrosis secondary to progressive massive fibrosis (silicosis), or any other tumor form of fibrosis; * Significant pulmonary arterial hypertension characterized by: Right ventricular failure on Doppler echocardiogram or Cardiac index \<2L / min / m2 in catheterization of right chambers; * Pneumothorax or extensive pleural effusion as the main determinant of ARF in the assessment of the attending physician; * Cardiogenic pulmonary congestion as the main determinant of IRPA in the assessment of the attending physician; * Presence of delirium or non-cooperation at the time of randomization; * Anatomical facial abnormalities; * Incoercible vomiting or hypersecretion of the airways; * Use of continuous VNIPP or HFNC for more than 8h before randomization; * pregnancy; * Refusal to participate.