Levels of monitoring of patients receiving noninvasive ventilation (NIV)

General wardHDUICU
Degree of severity of respiratory failureMildModerateSevere
 pH [10, 14, 28]7.35–7.307.30–7.20<7.20
 Respiratory rate breaths·min-1
  Restrictive disorders<3030–35>35
  Obstructive disorders<2525–35>35
 Level of consciousness
  Kelly's scale [121]12–45–6
 Failure of other organsNoDebatableYes
 OxygenationCorrected with low-flow oxygen (nasal prongs)Corrected with high-flow oxygen (Venturi mask or nonrebreathing mask)Not corrected with high-flow oxygen
 PaO2/FIO2 ratio [122–124]>150<150<100
 Medical staff surveillance
  Continuous nurse monitoringNot necessaryIndicatedObligatory
  Pulmonologist on dutyPreferableObligatoryPreferable
  Intensivist on dutyNot necessaryPreferableObligatory
 Clinical assessment
  Blood pressureOccasionalOccasionalContinuous
  Heart rate#OccasionalContinuousContinuous
  Respiratory rateOccasionalContinuousContinuous
  Level of consciousnessNot necessaryFrequentFrequent
 Gas exchange
  SpO2Every 2–4 hContinuousContinuous
  Arterial blood gas analysisEvery 8 hEvery 2–4 hFrequent by arterial line
  PtcCO2Not necessaryIndicatedIndicated
 Ventilator parameters
  Leak, VTE, I:E, VEEvery 2–4 hEvery 1 hContinuous
  Patient–ventilator asynchronyOccasionalFrequentFrequent
  Flow tracesNot necessaryIndicatedObligatory
  Compliance and resistanceNot necessaryIndicatedObligatory

Note that most of the values are not scientifically confirmed and cannot be understood as strict cut-off points, but rather as helpful tips to manage a patient receiving NIV. HDU: high-dependency unit; ICU: intensive care unit; GCS: Glasgow coma scale; PaO2: arterial oxygen tension; FIO2: inspiratory oxygen fraction; SpO2: arterial oxygen saturation measured by pulse oximetry; PtcCO2: transcutaneous carbon dioxide tension; VTE: expiratory tidal volume; I:E: inspiration to expiration ratio; VE: minute ventilation. #: by ECG monitoring; : first assessment should be made within first hour of NIV, then depending on patient's clinical state and always in cases of deterioration; frequency should be maintained until improvement and stabilisation of respiratory insufficiency.