No role for trial of CPAP? Seems like a fast way to exhaust ICU resources..https://twitter.com/wuidq/status/1240750407716089856?s=21 …
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4/ If you've personally had experience with pts who progress from 5L NC to maxed on HFNC(aka CPAP 5) in 6hrs and then turn around with BiPAP, feel free to respond.
again i’m not saying NiV and disappear but short trial of NiV for a couple of hours might be wise to see who flies and who doesn’t. linked ERCast suggests they’ve significant reduced # of intubations using that strategy
Are you treating them? I am, for nearly a month now. I didn't say they all crash. Many do fine on 5L and go home. Many do well with HFNC. We also use other NPPV for DNI pts, or for pts whose trajectory seems slower than usual.
we have several but not allowed to use NiV-> intubate early but i question the dogma given dwindling ICU resources (and I would want NiV trial). In italian podcast he says half do well on CPAP, the other half declare themselves and get intubated after couple of hours obs
2/ Per my personal experience, when these pts are progressing rapidly, that progression will continue, rapidly, to ETT. Attempting to bridge with BiPAP as we would in other circumstances is not helpful. Remember that a crash intubation is also aersolizing.
3/ Haven't seen one yet that got tubed too early and extubated. Not one. Some centers do early intubation, some don't. It's a clinical decision. But it's not helpful to be here saying the ONLY issue with NPPV is aerosolization, when it isn't.
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