Box 1.

Questions to determine whether escalation to invasive mechanical ventilation is appropriate if non-invasive ventilation is failing

  • Has non-invasive ventilation been delivered optimally (in terms of quality of mask fit, patient–ventilator synchrony, and appropriate escalation of pressures)?

    • If not, adjust or change interface and make appropriate changes to ventilator settings

  • How long has the patient been in hospital?

    • The longer the patient has been in hospital, the less likely a favourable outcome with non-invasive ventilation

  • Are any factors still potentially reversible?

    • If not, there is a risk of prolonging the dying process

  • What was the patient's functional status before admission?

    • A poor functional status is associated with a worse outcome

  • The more yes answers, the less likely a successful outcome will be reached even with invasive mechanical ventilation. Reproduced with permission from Bourke SC, Piraino T, Pisani L, Brochard L, Elliott MW. Beyond the guidelines for non-invasive ventilation in acute respiratory failure: implications for practice. Lancet Respir Med 2018;6:935–47.14