Neuromuscular Compromise and Respiratory Failure Clinical Pathway — Inpatient and PICU
Neuromuscular Compromise and Respiratory Failure Clinical Pathway — Inpatient and PICU
Requires Invasive Ventilation
Guidance on Patients Who May Require Invasive Ventilation Initially or After Maximizing NIV
The need for invasive ventilation should be based on the patient's trajectory and should generate a discussion between the primary intensivist team, respiratory therapy, pulmonary, and the patient/family.
Common Reasons that a Patient Would Require Invasive Ventilation
- Increased airway clearance requirements – suctioning, MI-E (CoughAssist) greater than q2 hours
- Measures of gas exchange – TcCO2, EtCO2, blood gas
- Need for FiO2 40-60% despite attempts to wean
- Persistent tachycardia
- Fatigue
- Diaphoresis
- Increased NIV settings:
- IPAP > 24 cmH2O/EPAP > 10 cmH2O
- or
- IPAP > 8 cmH2O above baseline/EPAP > 4-6 cmH2O above baseline