Approach to Acute Respiratory Failure
General framework consistent with current ARF/ARDS guidelines · Last reviewed: Jul 2026
1
Initial Action
Assess ABC, pulse oximetry, ECG, IV access. Oxygen if hypoxic — avoid excessive hyperoxia.
2
Decision
Classify type of respiratory failure (blood-gas analysis):
Type 1 (hypoxaemic) — suspect ARDS, pneumonia, pulmonary oedema, pulmonary embolism. Type 2 (hypercapnic) — suspect COPD exacerbation, central respiratory depression, respiratory muscle weakness.
3
Decision
Need ventilatory support?
Mild–moderate distress, alert → try HFNC or NIV (CPAP/BiPAP). Severe distress / cannot protect airway / NIV failure → intubate (see Rapid Sequence Intubation).
General approach — disease-specific detail lives in individual algorithms (Asthma, COPD, ARDS).