Patil-Syracuse Mask For Fiberoptic Intubation

76 yo M with a PMH of aspiraiton PNA s/p CVA and COPD presents with sob.

VSS: 110, 28, 83% on RA ambulance got him to 93% on BiPAP 10/5 100% fio2, 105/60, 38.8 (oral)

Patient is 320 lbs and is a known difficult airway from prior intubations from similar events. He had to be rescued from failed RSI with an LMA and required aintree fiberoptic intubation by anesthesia.

You think the patient is going to fail BiPAP but you have bought yourself some time.