How to intubate a patient previously on NIV?
Case 1 This patient has significant respiratory compromise, with type 2 respiratory failure – her PaO2 is low and her PaCO2 is raised. Without ventilatory support she will deteriorate further. It would be reasonable to intubate and mechanically ventilate this patient, but since her illness suggests that she is immunocompromised, her chance of survival will be better with NIV. She is not yet moribund and therefore likely to be responsive and co-operative. She is not profoundly hypoxic (currently only in 40%) but is tiring and so it would be reasonable to start BiPAP in an attempt to improve her CO2 clearance and modestly improve her oxygenation. Suggested initial BiPAP settings are: FiO2 40%, IPAP 10, EPAP 5 using a spontaneous mode delivered through a full face mask. You should to gauge her response to NIV after 10-15 minutes, by assessing her: Oxygenation · If her SaO2 improves then NIV is a good choice and you can consider reducing her FiO2. There is little benefit in decreasing EPAP
