NIV: BiPAP, CPAP & HFNO

• Best indications: acute cardiogenic pulmonary edema, COPD exacerbation with acidosis, plus post-extubation support in high-risk patients.
• Start BiPAP at IPAP 15 (20 if pH <7.25) / EPAP 4–5, or CPAP 5–10 for APE; HFNO is the alternative for hypoxemia.
• Reassess NIV at about 1 hour and frequently thereafter: evaluate pH, respiratory effort/rate, consciousness and oxygenation, and optimize interface/settings. Intubate promptly for deterioration or persistent clinical failure despite optimized support. In pneumonia/ARDS, use NIV only with careful selection and close monitoring; do not prolong a failing trial.
• Skip NIV with vomiting, facial trauma, an unprotected airway, or immediate arrest.

Acute respiratory failure

First tests: Pulse oximetry with oxygen device/FiO2, Arterial blood gas, Chest X-ray, Sodium, potassium, bicarbonate, urea and creatinine.

Only if indicated: Bedside echocardiography, Respiratory culture, CT pulmonary angiography.

Repeat monitoring: Arterial blood gas, Pulse oximetry with oxygen device/FiO2.

Acute COPD exacerbation

First tests: SpO2 and respiratory assessment, Arterial blood gas, Chest X-ray, 12-lead ECG, Full blood count, Sodium, potassium, bicarbonate, urea and creatinine.

Only if indicated: Respiratory culture, CT pulmonary angiography.

Repeat monitoring: Arterial blood gas.

• Initiating BiPAP in a Patient With a COPD Exacerbation