Acute respiratory failure is an emergency that requires a management strategy tailored to the individual patient and to the resources available. Endotracheal intubation is definitive airway management, but it can have complications. In addition, rapid sequence intubation (RSI) requires a degree of preparation and time that might not be available in the acutely distressed patient. For example, important equipment needs assembly, often the clinical environment is not optimal (such as with refractory hypoxia or abnormal anatomy that makes RSI riskier), or the patient has an underlying condition that could lead to further complication as a result of paralysis (such as in acidosis). Ultimately, with RSI there is a level of risk to the patient, both during the initial procedure of induction, sedation, laryngoscopy, and tube delivery, as well as post procedure, with ventilator-associated risks such as pulmonary barotrauma or ventilator-associated pneumonia.
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