If persistent or worsening respiratory distress occurs despite the use of high-flow oxygen devices, escalate the patient’s care:
A. Type I Respiratory Failure:
- Hypoxemic (e.g., acute pulmonary edema or ARDS):
- Consider CPAP to improve oxygenation.
B. Type II Respiratory Failure
- Hypercapnic (e.g., COPD exacerbation):
- Consider BiPAP to improve both oxygenation and ventilation.
Contraindications to NIV:
- Decreased level of consciousness (inability to protect the airway)
- Facial trauma or burns
- Excessive secretions
- Recent upper airway or GI surgery
Endotracheal intubation should be considered in the event of contraindications to NIV or failure to respond to less invasive measures.