Postoperative respiratory failure (PRF) remains a pervasive clinical challenge that substantially contributes to perioperative morbidity, mortality, and prolonged ICU stay. Although conventional oxygen therapy is often sufficient, a significant subset of high-risk patients requires escalation to advanced non-invasive support to avoid reintubation and invasive mechanical ventilation. Evidence from recent randomized trials, including the 2025 RENOVATE and Goret et al. studies, indicates that both non-invasive ventilation (NIV) and high-flow nasal oxygen (HFNO) reduce postoperative pulmonary complications and reintubation in selected high-risk populations. While NIV is preferred for hypercapnic ventilatory failure and is commonly used in selected high-risk cardiac surgery patients, HFNO offers comparable outcomes in pure hypoxemic failure with the added benefits of superior patient tolerance and a lower incidence of interface-related complications. Effective PRF management necessitates an individualized, physiology-based approach. By implementing a phenotype-driven algorithm that aligns device mechanics with the dominant pathophysiology, such as atelectasis versus pump failure, clinicians can optimize patient outcomes while minimizing the specific risks associated with delayed intubation.
Shaik et al. (Fri,) studied this question.