Acute respiratory failure (ARF) requires a structured, evidence-based approach that corrects hypoxemia while avoiding the separate harms of both under- and over-oxygenation. The choice of respiratory support modality and adjunct strategies is shaped by the severity of hypoxemia and the underlying disease.

Primary Clinical Target

The central goal is maintaining adequate oxygenation — with PaO₂ kept between 70 and 110 mmHg — avoiding both excess hypoxemia and hyperoxemia throughout the course of management.

Management Approach (Partial Overview)

Respiratory support selection in ARF involves weighing several modalities based on hypoxemia severity and the underlying disease; high-flow nasal cannula oxygenation (HFNC) is among the options addressed in the evidence base. Fluid management strategy and pharmacotherapy directed at the cause of hypoxemia also form part of the approach — the complete decision framework and full regimen are in the structured protocol.

References

DOI: 10.1186/s40560-023-00658-3

In ARF, the choice between the use of nasal cannula, HFNC, NPPV, or invasive positive pressure ventilation (IPPV) is based on the presence of underlying disease and severity of hypoxemia.
In the HFNC guidelines by the American College of Physicians, HFNC was weakly recommended for ARF over NPPV due to a systematic review reporting that HFNC for ARF is associated with lower mortality and a lower intubation rate compared to NPPV.
Based on this evidence, the JRS/JSICM/JSRCM-GL2021 and FICM/ICS-GL 2018 weakly recommend restrictive fluid management.
In ARF, pharmacotherapy should be focused on the underlying disease or diseases that are causing hypoxemia.
PaO2 was maintained between 70 and 110 mmHg in both groups in all studies.

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What Is the Treatment of Acute Respiratory Failure? Oxygenation Targets and Respiratory Support

References