When a patient on CPAP has worsened respiratory distress, what action should be taken?

When a patient on Continuous Positive Airway Pressure (CPAP) experiences worsened respiratory distress, switching to mechanical ventilation is a critical intervention. This approach is justified because CPAP is typically effective for patients who require assistance with breathing but are capable of maintaining some respiratory function on their own. However, when a patient shows signs of severe respiratory distress, it indicates that they may not be maintaining adequate ventilation or oxygenation.

Mechanical ventilation provides more controlled respiratory support and can deliver positive pressure breaths at a set rate and volume, which is vital for patients who are unable to sustain adequate ventilation. This transition allows for close monitoring and adjustment of ventilation parameters to optimize oxygenation and carbon dioxide elimination, addressing the immediate needs of the patient who is in respiratory failure or at risk of further deterioration.

In this scenario, simply increasing oxygen delivery or adjusting the positive end-expiratory pressure (PEEP) may not adequately address the underlying issues causing the deterioration. Bag-mask ventilation serves as a temporary measure primarily in emergencies or while preparing for more definitive support, but does not provide the continuous care and monitoring that mechanical ventilation offers. Therefore, transitioning to mechanical ventilation is a more appropriate response to ensure the patient receives sufficient respiratory support in the face of acute distress.