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Airway situation
Flash Pulmonary Edema / SCAPE Airway
Many SCAPE patients improve with rapid NIV, PEEP, and afterload reduction. Intubation may be necessary, but the best airway move is often aggressive noninvasive stabilization first.
SCAPEpulmonary edemaNIVPEEP
Clinical-use limit: Educational resource and cognitive-aid guide only; not a bedside order set or substitute for local protocol, medical direction, or clinical judgment.
Before intubation
- Use NIV/CPAP/BiPAP early when mental status and aspiration risk allow.
- Treat physiology: afterload reduction and diuresis/vasodilator strategy per local protocol.
- Prepare for desaturation and hemodynamic change if intubation becomes unavoidable.
During intubation
- Keep PEEP and oxygenation strategy continuous through induction when feasible.
- Avoid prolonged apnea and hypotension.
- Use skilled first attempt and confirm with waveform EtCO2.
After intubation
- Match ventilator PEEP/FiO2 to oxygenation while reassessing blood pressure and perfusion.
- Continue definitive SCAPE therapy and reassess work of breathing, oxygenation, and CXR/POCUS findings.
- Do not abandon afterload management after the tube.
Common pitfalls
- Intubating before trying NIV in an appropriate patient.
- Dropping PEEP during transition.
- Ignoring post-intubation hypotension from induction and positive pressure.