Noninvasive ventilation (NIV) is often used in the resuscitation of critically ill patients with acute hypoxemic or hypercapnic respiratory failure.
Given the frequency of its use in both EDs and ICUs, it is important to recognize NIV failure and when patients should undergo intubation and initiation of mechanical ventilation.
Patients should be re-evaluated within approximately 60 minutes of initiation of NIV.
The HACOR score is a risk scoring tool comprised of heart rate, acidosis, consciousness, oxygenation, and respiratory rate and can be used to detect NIV failure in the hypoxemic patient.
Consider intubation in a patient with a HACOR score > 5 at 1-2 hours after NIV initiation.
References
Frat JP, et al. Noninvasive respiratory supports in the ICU. Intensive Care Med. 2025; 51:1476-89.
