目的 此共识旨在为危重患癌症患者的急性呼吸衰竭（ARF）的诊断和治疗提供基于证据的建议。方法 我们根据PICO（人群、干预、比较和结果）原则，制定了六个关于危重患癌症患者急性呼吸衰竭（ARF）的诊断和治疗的临床问题。通过文献搜索和荟萃分析，制定了相应的建议。应用GRADE（推荐评估、发展和评估）方法，让专家组达成共识。结果 专家组强烈建议：（1）使用基因组学下一代测序（mNGS）检测可能有助于快速诊断疑似患有肺部感染的危重患癌症患者；（2）超低温体外膜氧合（ECMO）治疗不应作为危重患癌症患者急性呼吸窘迫综合征的例行救治方法，在多学科会诊后选择高度筛选患者可能获益；（3）与标准化疗相比，接受免疫检查点抑制剂治疗的癌症患者发生肺炎的概率增加；（4）危重患癌症患者使用侵入性机械通气，估计拔管时间大于14天时，早期气管切开术可能会获益；（5）高流量鼻导氧和非侵入性通气治疗可作为危重患癌症患者的一线氧气治疗策略，并且相对较弱的建议是：（6）对于由肿瘤压迫引起的危重患癌症患者的急性呼吸衰竭，仅建议对经过多学科会诊确定对抗癌治疗可能敏感的患者进行紧急化疗作为救治方法。结论 基于现有证据的建议可以指导危重患癌症患者急性呼吸衰竭的诊断和治疗，并改善预后。

Objective This consensus aims to provide evidence-based recommendations on common questions in the diagnosis and treatment of acute respiratory failure (ARF) for critically ill cancer patients. Methods We developed six clinical questions using the PICO (population, intervention, comparison, and outcome) principle in diagnosis and treatment for critical ill cancer patients with acute respiratory failure (ARF). Based on literature searching and meta-analyses, recommendations were devised. The GRADE (grading of recommendation assessment, development and evaluation) method was applied to each question to reach consensus in the expert panel. Results The panel makes strong recommendations in favor of (1) metagenomic next-generation sequencing (mNGS) tests may aid clinicians in the rapid diagnosis in critically ill cancer patients suspected of pulmonary infections;(2) extracorporeal membrane oxygenation (ECMO) therapy should not be used as a routine rescue therapy for acute respiratory distress syndrome in critically ill cancer patients, and may benefit to highly selected patients after a multi-disciplinary consultation;(3) cancer patients who received immune checkpoint inhibitor therapy have an increased incidence of pneumonitis compared with standard chemotherapy;(4) critically ill cancer patients who are on invasive mechanical ventilation and estimated to be extubated after 14 days may benefit from early tracheotomy;(5) high-flow nasal oxygen and noninvasive ventilation therapy can be used as a first-line oxygen strategy for critically ill cancer patients with ARF, and a weak recommendation:(6) for critically ill cancer patients with ARF caused by tumor compression, urgent chemotherapy as a rescue therapy is recommended only to patients determined being potentially sensitive to the anticancer therapy after a multidisciplinary consultation. Conclusions The recommendations based on the available evidences can guide diagnosis and treatment in critically ill cancer patients with acute respiratory failure and improve outcomes.