Chronic respiratory failure
ICD-10 J96.1 · ICD-11 CB41.1

Chronic Respiratory Failure: What to Do When High-Flow Nasal Cannula Has Not Maintained Target Oxygenation

Clinical Scenario

This protocol addresses patients with chronic respiratory failure in whom high-flow nasal cannula (HFNC) oxygenation has been trialled as the initial approach. When HFNC does not achieve the required oxygenation targets, a defined next-line intervention applies.

Previous Line — Failure Condition

High-flow nasal cannula oxygenation (HFNC) did not maintain PaO₂ within the target range of 70–110 mmHg, failing to avoid both excess hypoxemia and hyperoxemia.

This unmet oxygenation goal is the threshold that triggers escalation to the next structured treatment step.

Next-Step Approach

After HFNC fails to meet oxygenation targets, the next intervention involves a form of noninvasive ventilatory support. In respiratory failure, the selection between available ventilatory strategies is guided by the underlying disease and the degree of hypoxemia.

The full protocol — including the specific modality, application approach, and monitoring parameters — is available via the link below.

Instant Access to Structured Evidence-Based Regimens

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.

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