Acute respiratory failure is not a single clinical entity but represents the final common pathway of many disparate precipitating causes. It is complicated by patient heterogeneity and variation in response to underlying diseases. Acute respiratory failure is a dynamic process, and frequent assessment of the patient and responses to therapy are required. Therapeutic intervention in acute respiratory failure should match acute and chronic changes in physiology with the nature and severity of the initiating insult. Detailed premorbid medical and social histories facilitate interpretation of acutely measured variables and the setting of appropriate therapeutic targets. As it is not possible to define acute respiratory failure in every clinical setting, a conceptual overview of available therapeutic options to management will be provided, with particular reference to acute lung injury and acute respiratory distress syndrome (ARDS). Secondly, a therapeutic strategy is proposed that might synthesize these interventions into a rational approach to management.

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