[Non-invasive respiratory support for acute respiratory failure with focus on high-flow oxygen therapy and...

Acute respiratory insufficiency (ARI) is among the most frequent emergencies in emergency and intensive care medicine and is associated with mortality rates of up to 50%. Pathophysiologically, ARI is classified into hypoxemic, hypercapnic, and mixed forms. Hypoxemic insufficiency typically results from parenchymal lung disease or ventilation-perfusion mismatch, whereas hypercapnic insufficiency reflects pump failure. Monitoring includes clinical assessment, respiratory rate, pulse oximetry, and blood gas analysis; capnometry as well as advanced techniques such as electrical impedance tomography or esophageal pressure measurement may be used as adjuncts. Therapeutically, high-flow oxygen therapy (HFOT) and non-invasive ventilation (NIV) have become established. HFOT improves comfort, secretion clearance, and oxygenation, while NIV is particularly effective in hypercapnic insufficiency. Both modalities can reduce the need for intubation but require close monitoring and timely escalation in case of treatment failure.