• Decisions on whether or not to intubate should be made in consultation with the patient (if possible), the family, and a respiratory physician with knowledge of the patient. The patient should be given the benefit of the doubt and intubated in an acute situation where a precise history and quality of life is not known.

• Trials of non-invasive ventilatory support ± respiratory stimulants such as doxepram have shown considerable success in avoiding intubation and mechanical ventilation.

• Accept lower target levels of PaO2

• Accept higher target levels of PaCO2 if patient is known or suspected to have chronic CO2 retention on the basis of elevated plasma bicarbonate levels on admission to hospital.

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