Respiratory Anaesthesia & Critical Care

HACOR Score for NIV Failure Risk

Heart rate, Acidosis, Consciousness, Oxygenation and Respiratory rate (HACOR) predicts failure of non-invasive ventilation (need for intubation) in hypoxaemic patients, assessed after 1 hour of NIV (Duan 2017: 449 patients, validated in 358). At 1 h, a score > 5 predicted failure with sensitivity 72.6% and specificity 90.2%.

Score interpretation

HACOR ≤ 5 — Lower Risk of NIV Failure 0–5

HACOR ≤ 5 after 1 hour of NIV — NIV likely to succeed; keep reassessing.

→ Continue NIV and optimise settings, mask fit and synchrony; reassess HACOR and blood gases; keep an airway plan available.

HACOR > 5 — High Risk of NIV Failure 6–25

HACOR > 5 after 1 hour of NIV — high risk of NIV failure; in Duan 2017, intubation within 12 h was associated with lower hospital mortality than later intubation.

→ Senior ICU / anaesthetic review; plan early controlled intubation unless a ceiling of treatment applies; document the decision and treat the underlying cause.

Interpretation bands for the HACOR Score. Apply clinical judgement and local guidance.

References

Duan J, Han X, Bai L, Zhou L, Huang S. Assessment of heart rate, acidosis, consciousness, oxygenation, and respiratory rate to predict noninvasive ventilation failure in hypoxemic patients. Intensive Care Med. 2017;43(2):192–199.
Scala R, Pisani L. Noninvasive ventilation in acute respiratory failure: which recipe for success? Eur Respir Rev. 2018;27(149):180029.

Curated clinical cross-links plus same-class fallbacks.

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

Related