Non-invasive ventilation (NIV) is applied worldwide to patients with hypoxemic respiratory failure. It is often applied as an attempt to avoid invasive mechanical ventilation.

However, the application of NIV is often ad hoc and non-evidence based. Duan et al. have developed a scoring system which accurately predicts patients that would be at risk of NIV failure such that the clinician can plan for the decision to implement invasive mechanical ventilation.

Duan et al utilised a test cohort of 449 patients and performed a univariate analysis to determine variables associated with NIV failure at one hour of NIV.

They subsequently developed a regression model by entering variables from step 1 that showed a p<0.2 into a stepwise multivariate logistic regression analysis. They subsequently developed a risk scale for each variable. This scale was then applied to a prospective validation cohort. Heart rate, Acidosis (pH), Consciousness (GCS), Oxygenation, and Respiratory rate (HACOR) is a potentially useful bedside tool for the prediction of NIV failure. HACOR score accurately predicts NIV failure in patients with hypoxemic respiratory failure in this single centre study.

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