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Non-Invasive Ventilatory Support in Postoperative Respiratory Failure: A Phenotype-Driven Approach to Risk Stratification and Modality Selection
Journal article   Open access   Peer reviewed

Non-Invasive Ventilatory Support in Postoperative Respiratory Failure: A Phenotype-Driven Approach to Risk Stratification and Modality Selection

Roshan Shaik, Dylan M. Persaud, Rohail Gul and Perry John Tiberio
Complications, v 3(2), 8
03 Apr 2026
DOI: https://doi.org/10.3390/complications3020008
Featured in Collection :   Drexel's Newest Publications
url
https://doi.org/10.3390/complications3020008View
Published, Version of Record (VoR)Open Access Discount via Drexel Libraries Read and Publish Program 2026CC BY V4.0,  Open

Abstract

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.

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