Treatment failure

Treatment failure with noninvasive ventilation may be indicated by clinical deterioration, increasing distress or deteriorating arterial blood gas results.

If treatment failure occurs, consider:

• need for intubation and mechanical ventilation
• whether medical treatment for underlying condition has been optimised
• chest X-ray to exclude pneumothorax or aspiration pneumonia
• ventilation perfusion isotope (V/Q) lung scan or computed tomography pulmonary angiography (CTPA) to exclude pulmonary embolus
• chest physiotherapy for airway clearance.