Clinical Scenario
Type 2 respiratory failure & NIV criteria
INDICATIONS FOR NIV
COPD with respiratory acidosis (pH 7.25–7.35, PaCO₂ >6) despite ≥1 hour of medical therapy and controlled O2 (target SpO2 88–92%), cardiogenic pulmonary oedema (CPAP first line), neuromuscular failure, OSA/obesity-related hypoventilation, weaning from invasive ventilation.
CONTRAINDICATIONS
Reduced GCS without reversible cause, facial trauma/burns, vomiting, undrained pneumothorax, fixed upper-airway obstruction, severe haemodynamic instability, inability to tolerate the mask.
STARTING
- IPAP 12–15, EPAP 4–5, FiO2 to target SpO2 88–92%.
- Reassess clinically and ABG at 1 and 4 hours.
- Escalate IPAP in 2–5 cm increments to maximum 25.
CRITICAL DECISIONS
- Document a ceiling of care before starting (NIV → intubate?
- NIV ceiling? palliative?).
- Discuss with critical care early if pH <7.25 or no improvement at 1 hour.
- Failed NIV at 4 hours is a strong predictor of mortality.