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Clinical assessment outweighs any objective measurement such as an arterial blood gas or chest x-ray.
Consider initiating mechanical ventilation in the absence of:
An impaired conscious state
A threatened airway
Fatigue or imminent exhaustion
An inability to effectively cough or clear secretions
Progressive hypoxaemia evidenced by pulse Oximetry
In the appropriate clinical setting, and where time allows the following objective measurements may assist in making the decision to initiate mechanical ventilation.
A respiratory rate of greater than 30 breaths per minute or a progressive increase in respiratory rate.
Abnormal oxygenation as evidenced by a PaO2 of less than 75 mmHg on greater than 40% inspired oxygen
A depressed minute ventilation as evidenced by a rising PaCO2
Level of consciousness
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