The HACOR Score can Predict Failure of Noninvasive Positive Pressure Ventilation or BiPAP

Use of noninvasive positive pressure ventilation (NPPV) or BiPAP can temporarily support ventilation during initial treatment in some patients with respiratory failure. However, many patients fail NPPV and ultimately need intubation. Early intubation or close observation can benefit patients at risk for NPPV failure. The authors of the following study derived and validated a score to predict NIV failure in patients with hypoxemic respiratory failure admitted to a respiratory ICU in China.

A stepwise multivariable regression analysis was used to identify parameters measured one hour after initiation of NPPV in order to predict NPPV failure. This study had 449 subjects whose parameters were studied. The following parameters were identified: Heart rate, Acidosis, Consciousness, Oxygenation, and Respiratory rate (HACOR). Each parameter was assigned points and the sum of those points represented the HACOR score. The HACOR score ranged between 0 to 25 points and a higher score signified a greater chance of NPPV failure. The HACOR score was validated in a second cohort of 358 subjects.

In total, 46% of patients ultimately failed NPPV. For predicting need for intubation, a HACOR score of 6 or more was highly predictive of NPPV failure.  Overall, only 18% of patients with a HACOR score ≤5 failed NPPV, compared to 78% with a score of 6 or more.


  1. Duan J et al. Assessment of heart rate, acidosis, consciousness, oxygenation, and respiratory rate to predict noninvasive ventilation failure in hypoxemic patients. Intensive Care Med 2016 Nov 3; [e-pub]. (
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