Not all co-morbidities correlate to poor clinical outcome, the Clinical Frailty Score (CFS) aligns with prognosis. Scores of 5 and above suggest minimal benefit with Critical Care interventions e.g. Intubation, mechanical ventilation.Assess each patient on their own merits using the following structure:
Their overall level of physical fitness
The presence or absence of any active disease symptoms (for example, well-controlled diabetes will impact frailty status much less than diabetes with complications like nerve, eye or heart problems)
Their level of dependency on other people for their activities of daily living (ADLs)
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:
