Noninvasive Ventilation for High-Risk Endotracheal Intubation

For patients with severe hypoxemic respiratory failure, significant hemodynamic instability, and/or abnormal upper airway anatomy, endotracheal intubation may be high risk for complications such as worse hypoxemia, hemodynamic collapse, and failed intubation. Noninvasive ventilation to support endotracheal intubation has emerged as a tool to transition high-risk patients in acute respiratory failure to invasive ventilation in place of bag-valve-mask ventilation and apneic oxygenation. Data supporting its use for the entire intubation process continue to be limited to case series. Nevertheless, the use of noninvasive ventilation to support the intubation process may help minimize perturbations in oxygenation and hemodynamics and potentially increase the chance for successful endotracheal intubation in high-risk patients.