Which of the following is a contraindication to non-invasive positive pressure ventilation?

• A Immunocompromised patient with early pneumonia and hypoxaemia
• B Respiratory acidosis with pH 7.25 in COPD exacerbation
• C Cardiogenic pulmonary oedema with SpO2 85% on facemask
• D Hypercapnic encephalopathy with GCS 9 and absent cough reflex ✓

Explanation

Reduced consciousness with an unprotected airway is a firm contraindication to NIV because of aspiration risk and inability to cooperate with the interface. Acidotic COPD exacerbation, cardiogenic pulmonary oedema and immunocompromised pneumonia are all established indications where NIV improves outcomes. Facial burns, vomiting and undrained pneumothorax are other classic contraindications; a pH of 7.25 actually strengthens the case for starting NIV promptly.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.