The interaction between the heart and lungs significantly influences the respiratory cycle, both in spontaneous breathing and during mechanical ventilation. It is crucial to thoroughly investigate the primary cause of respiratory failure when it is related to cardiac disease, as addressing this underlying issue is a key component of effective treatment. The interdependence between the heart and lungs can become life-threatening, with each system potentially exacerbating the other’s dysfunction and impacting multiple organs. Given this complex relationship, clinical findings must be evaluated with great care. In cases where necessary, advanced monitoring techniques and cutting-edge mechanical ventilation technologies should be employed to manage respiratory failure effectively. This chapter aims to explore advanced mechanical ventilation technologies and decision-making tools for managing respiratory failure that may arise from cardiac disease.