Critical Care Escalation

Patients may not improve despite optimal NIV setup, good medical and nursing care. In such situations, early critical care review is essential. Reminder: refer to ITU if not improving 1 hour after CPAP initiation for consideration of IMV if for full escalation and for daily ICU discussion if not improving on NIV. There are special circumstances when NIV is not appropriate, these include:

• Severe type 2 respiratory failure with pH <7.25
• Severe pneumonia
• Acute severe asthma (NEVER use NIV)