If a patient cannot tolerate a nonrebreather mask, what oxygen delivery strategy should be used?

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When a patient can’t tolerate a high- FiO2 delivery device, the goal is to provide meaningful oxygen while staying comfortable enough to use continuously. A nonrebreather mask offers the highest possible FiO2 but can be uncomfortable or intolerable for some patients due to the tight seal and bulky fit. Switching to a nasal cannula at the maximum comfortable flow delivers supplemental oxygen in a well-tolerated form and can still improve oxygenation, typically around 40–45% FiO2 at higher flows. It avoids leaving the patient at room air, which would worsen hypoxemia, and is generally easier to maintain than advancing to a ventilation mask in the field. Increasing the NRB flow won’t help if the mask is not tolerated, and applying a noninvasive ventilation mask introduces a different level of support that isn’t ideal for a patient who cannot tolerate a NRB.