Immediately implement NIV for patients who arrive to the ED in respiratory distress (particularly from acute exacerbations of COPD), after ensuring the absence of absolute contraindications. (See Table 1.) This may prevent the need for mechanical intubation. Risk Management Caveat: Be sure to closely monitor your patient on NIV with persistent respiratory distress. If there is, at any time, presence of an absolute contraindication, relative contraindication, or signs of NIV failure (see Table 3), then your patient will require intubation.
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