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

When a patient on CPAP (Continuous Positive Airway Pressure) exhibits worsened respiratory distress, the most appropriate action is to switch to mechanical ventilation. This recommendation stems from the understanding that CPAP is primarily used to support spontaneous breathing by providing a continuous flow of air to keep the alveoli open, but it may not adequately support patients who are experiencing significant respiratory failure or increased work of breathing.

In cases of severe respiratory distress, the patient may require more invasive support to ensure adequate oxygenation and ventilation. Mechanical ventilation can provide controlled breaths and allow for precise adjustments to tidal volume and pressure, which are crucial for patients who are unable to maintain their respiratory status with CPAP alone. By transitioning to mechanical ventilation, clinicians can also better manage underlying pathologies and adjust settings in a way that optimally meets the patient's needs.

Furthermore, options like decreasing the PEEP or increasing oxygen delivery can be helpful in certain circumstances but may not be sufficient interventions by themselves in the context of worsening respiratory distress. In many cases, bag-mask ventilation would only serve as a temporary measure rather than a definitive solution, especially if the underlying issues necessitate a more comprehensive approach such as mechanical ventilation.

Thus, switching to mechanical ventilation is the most suitable option when faced with significant respiratory