Frat et al reported predictors for eventual endotracheal intubation in a patient being treated in the intensive care unit (ICU) for acute hypoxemic respiratory failure with a noninvasive strategy. These factors can help to identify a patient who may benefit from early intubation. The authors are from multiple institutions in France.
Patient selection: acute hypoxemic respiratory failure in the ICU
A noninvasive oxygenation strategy may be started in order to avoid intubation. However, this may mask worsening respiratory failure. This strategy has a high rate (40-50%) of eventual intubation and subsequent mortality.
Methods of noninvasive oxygenation may include:
(1) face mask
(2) noninvasive ventilation (NIV)
(3) high-flow nasal cannula (HFNC)
Predictors of intubation for a patient on a noninvasive oxygenation strategy:
(1) PaO2/FIO2 ratio < 200 mm Hg
(2) tidal volume > 9 mL/kg
Predictors of intubation for a patient on standard oxygenation therapy:
(1) respiratory rate >= 30 breaths per minute under standard oxygen 1 hour after initiation
