| Problem | Solution |
| Mask leaks | Adjust headgear tension Change mask type |
| Persistent hypoxaemia | Increase ventilatory support Increase oxygen entrainment, usually little value from increasing to >4 L·min−1 Change to ventilator with oxygen blender |
| Asynchrony between patient and ventilator | Check for mask leak Check ventilator settings, particularly timing parameters; if pressure support, consider reduction |
| Hypocapnia/respiratory alkalosis | Reduce level of ventilatory support |
| Confusional state/aggressive behaviour | Maybe a role for sedation in a well-monitored environment |
| Nasal problems: rhinitis/nose bleeds/nasal congestion | Humidification Nasal steroids Short-term topical decongestants (beware of rhinitis medicamentosa) |
| Gastric distension | Check synchrony Reduce IPAP Consider wide-bore nasogastric tube |
| Respiratory rate and pH not improving despite resolution of any of the issues outlined above | Increase level of IPAP/pressure support |
IPAP: inspiratory positive airway pressure.