Recommended Guidelines for Intubation From Optimized Noninvasive Respiratory Support with nCPAP or HHHFNC Support

Apnea despite 30 seconds of PPV
Heart rate <100 beats per minute and not increasing despite 30 seconds of PPV
FiO2 >0.6 to maintain Spo2 ≥88%
Frequent or severe apnea and bradycardia
More than 1 apnea event per 12-hour period requiring PPV
Persistent marked/severe retractions
Suspected airway obstruction (despite adequate suctioning)
Cardiovascular collapse (heart rate <60 beats per minute or shock)
Severe metabolic acidosis (arterial base deficit > −10)
Severe respiratory acidosis (arterial pco2 >65 torr)
  • PPV, positive pressure ventilation; Spo2, pulse oxygen saturation.