Acute Respiratory Failure: Next Step When HFNC Fails to Maintain Adequate Oxygenation
In acute respiratory failure (ARF), when the initial oxygen delivery strategy does not achieve adequate oxygenation targets, structured escalation to the next treatment line is indicated.
Previous Line — Failure Condition
The preceding approach centred on high-flow nasal cannula oxygenation (HFNC) alongside supportive measures, with the goal of maintaining PaO₂ between 70 and 110 mmHg and avoiding both hypoxemia and hyperoxemia. When adequate oxygenation within this range is not achieved, escalation to this protocol is indicated.
Next-Line Approach — Partial Overview
This protocol applies a different mode of ventilatory support delivered non-invasively. The appropriate choice is guided by the severity of hypoxemia and the nature of the underlying disease. The complete structured regimen — including selection criteria, sequencing, and full clinical detail — is available via the link below.
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.