What alternatives to intubation can be used for refractory hypoxemia in bacterial pneumonia?

Updated: Sep 30, 2020
  • Author: Justina Gamache, MD; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Answer

An alternative to intubation for refractory hypoxemia may be use of continuous positive airway pressure (CPAP). Patients who are awake and can tolerate mask application may avoid intubation. However, in patients with productive cough, noninvasive ventilation is often avoided because it may impair clearance of respiratory secretions, which can lead to worsening infection and recurrent aspiration. Nasal CPAP is not usually as well tolerated as a full mask (which covers both the nose and mouth) in the emergent situation. Bi-level positive airway pressure (BiPAP) may be employed as a means of noninvasive ventilation in patients with hypercarbia.


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