Acute hypoxemic respiratory failure (ARF) is characterized by both lower arterial oxygen and carbon dioxide tensions in the blood. First line treatment for ARF includes oxygen therapy – intially administered non invasively using nasal prongs, high flow nasal cannulae (HFNC) or masks. Invasive mechanical ventilation (IMV) is usually reserved for patients who are unable to maintain their airway, those with worsening hypoxemia, or those who develop respiratory muscle fatigue and consequent hypercapnia. Inhaled nitric oxide (iNO) gas is known to improve oxygenation in patients with ARF by manipulating ventilation-perfusion matching. Addition of iNO may potentially alleviate the need for IMV in selected patients. In this article we report our preliminary experience of using HFNC to deliver oxygen and nitric oxide gas in patients with hypoxemic ARF as a strategy to potentially avoid IMV in selected patients. This article demonstrates the feasibility of this technique based on our experience of patients with hypoxemic ARF and generates hypothesis for future studies. • First line treatment for hypoxemic ARF includes oxygen therapy using nasal prong or face masks, high flow nasal cannula (HFNC) or non-invasive ventilation techniques. • Invasive mechanical ventilation (IMV) is usually reserved for patients who are unable to maintain their airway, those with worsening hypoxemia, or those who develop respiratory muscle fatigue. • Nitric oxide gas inhalation has been shown to improve oxygenation in patients with hypoxemic ARF by manipulating ventilation-perfusion matching. • We report the feasibility of adjunctive nitric oxide inhalation via HFNC to treat hypoxemia and to avoid IMV and related complications in selected patients. • Randomised controlled trails that test the effectiveness of this strategy in reducing the need for endotracheal intubation are indicated. [ABSTRACT FROM AUTHOR]