pediatrics Interfaces should be chosen balancing the desire to maximize comfort and compliance while ensuring minimal leak In addition to pressure, NIV can also deliver supplemental oxygen and inhaled therapies such as albuterol or racemic epinephrine Similar to HFNC, NIV can be used for either acute hypoxic or hypercarbic respiratory failure CPAP may be appropriate when hypoxemia is the primary indication Because it delivers higher mean airway pressures while offloading inspiratory effort, BPAP can be used for more severe hypoxemia and to address hypercapnia Multiple parameters can be titrated with NIV, including CPAP (typically 5- to 10-cm H2 O), EPAP and IPAP (typically to 10 cm H2 and to 22 cm H2 O, respectively), FiO2 , and backup ventilation rate for patients experiencing intermittent apnea or hypopnea If successful, NIV eliminates some complications related to intubation, such as laryngeal or tracheal injury or ventilator-associated pneumonia, as well the risks associated with sedation and neuromuscular blockade NIV should not be used in patients requiring immediate endotracheal intubation, or those with impaired mental status or requiring airway protection Relative contraindications include facial injury, upper gastrointestinal bleeding, untreated pneumothorax, and significant or escalating vasopressor support Most children, with appropriate coaching and provider patience during initiation, will tolerate NIV though some require anxiolysis or sedation Beyond the potential for failure of NIV, the significant complications include barotrauma, aspiration, and hemodynamic instability due to decreased venous return Minor complications include skin breakdown, eye irritation, nasal mucosal trauma, and gastric distention APPROACH TO ENDOTRACHEAL INTUBATION Rapid sequence intubation (RSI) is the favored approach when advanced airway management is required in pediatrics RSI can optimize intubating conditions and results in higher intubation success rates than sedation alone approaches In brief, RSI involves the near simultaneous administration of a sedative and neuromuscular-blocking agent (NMBA) to render a patient unconscious and immobile, with blunted natural airway reflexes In pure RSI, bag mask ventilation is not performed to avoid gastric insufflation and increased risk of aspiration in patients presumed not to be fasted Modified or controlled RSI differs in that it includes the delivery of gentle positive pressure breaths following medication administration to prevent hypoxia or hypercarbia during apnea Sedation-only intubation may be preferred in cases of upper airway obstruction or in cases