Predicting NIV Failure

• 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.