PACULit Daily Literature Update: Prevalence risk factors and consequences of early clinical deterioration under noninvasive ventilation in emergency department patients a prospective multicentre observational study of the French IRU Network Quiz

John is a 72-year-old male presenting to the emergency department with acute respiratory failure secondary to COPD exacerbation. His medical history includes hypertension and mild cognitive impairment. On assessment, his Glasgow Coma Scale (GCS) score is 13, heart rate is 120 bpm, and he exhibits increased work of breathing with use of accessory muscles. He was started on non-invasive ventilation (NIV) in the ED. The pharmacist is reviewing his clinical status and monitoring parameters.

Which of the following clinical findings most strongly indicates John is at high risk for early clinical deterioration under NIV within the first hour?

Maria, a 65-year-old female with acute hypoxemic respiratory failure, is receiving NIV in the emergency department. After 1 hour of NIV, she remains tachycardic with a heart rate of 118 bpm, has a GCS of 15, but continues to show signs of increased work of breathing. The pharmacist is consulted to advise on the next steps.

Based on the study findings, what is the most appropriate pharmacist recommendation regarding Maria’s care?

Ahmed is a 70-year-old male admitted to the emergency department with acute respiratory failure and started on NIV. At 1 hour, he shows early clinical deterioration but is not intubated immediately. The pharmacist is counseling the care team on prognosis and follow-up.

What does the presence of early clinical deterioration under NIV imply about Ahmed’s 7-day outcomes according to the study?