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Critical care in the emergency department: acute respiratory failure
  1. Patrick A Nee1,
  2. Mohammad A Al-Jubouri1,
  3. Alasdair J Gray2,
  4. Charlie O'Donnell3,
  5. Dan Strong4
  1. 1St Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Prescot, Merseyside, UK
  2. 2Royal Infirmary of Edinburgh, Edinburgh, UK
  3. 3Whipps Cross University Hospital, Leytonstone, London, UK
  4. 4University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
  1. Correspondence to Dr Patrick A Nee, St Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Prescot, Merseyside L35 5DR, UK; patrick.nee{at}


Acute respiratory failure (ARF) is a frequent emergency department (ED) presentation. The definition and common causes of ARF are discussed in this article and ED management of the condition is discussed, using an illustrative case report. The paper considers the role of B-type natriuretic peptide in diagnosis and non-invasive ventilation (NIV) in treatment. Intensive care unit admission denial is common in ARF, although the evidence base is lacking. Finally, the decision-making process is described when a patient with ARF fails to improve with NIV.

  • Cardiac care
  • chronic obstructive pulmonary disease
  • heart failure
  • intensive care
  • respiratory
  • ventilation

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  • Competing interests None.

  • Provenance and peer review Commissioned; not externally peer reviewed.