Non-Invasive Ventilation

Flashcards for Non-Invasive Ventilation Lecture

What are the two main types of non-invasive ventilation?

Negative pressure ventilation and Positive pressure ventilation.

What is the primary goal of NPPV in the acute care setting?

To avoid intubation.

What are some acute care settings where NPPV can be used?

Acute exacerbation of COPD, Asthma, Hypoxemic Respiratory Failure/ARDS, Community-Acquired Pneumonia, and Cardiogenic Pulmonary Edema.

What are the benefits of CPAP in treating OSAS?

Low levels of continuous pressure act as a pneumatic splint preventing airway collapse or obstruction during sleep.

What are some chronic or homecare settings where NPPV can be used?

OSAS, Nocturnal hypoventilation syndrome, Restrictive disorders, Chronic neuromuscular conditions, and Chronic stable COPD.

What are the main categories of patient interfaces for NIV?

• Nasal Interfaces

• Full-face (Oronasal) Interface,

• Total Face and Helmet Interfaces

• Oral Interfaces.

What are the advantages of using a nasal mask?

• Easy to fit quickly,

• less risk of claustrophobia

• lower risk of aspiration

• patient can cough and speak

• less mechanical dead space

What are the disadvantages of using a nasal mask?

• Mouth Leaks

• Eye and facial skin irritation

• Ulceration over bridge of nose

• Oral and nasal dryness

• nasal congestion

• Increased resistance through nasal passages

What are the advantages of using full-face (Oronasal) masks?

• Reduces air leakage through mouth

• Less airway resistance

What are the disadvantages of using full-face (Oronasal) masks?

• Increased risk for aspiration,

• Increased risk for asphyxia,

• Increased dead space,

• Claustrophobia,

• Difficult to secure and fit,

• Facial irritation/ulceration,

• Must remove to speak or expectorate secretions

What is an important consideration for emergency/critical care interface selection?

Patients tend to have increased shortness of breath, and Full-face mask is recommended, but the patient must be observed for potential risk of aspiration.

What is the appropriate patient position during NIV setup?

Patient sitting up or at least Semi-Fowler’s position.

What factors should be monitored after NIV setup?

Vital signs and ABG within 1 hour.

How can oxygenation be improved during NIV?

• Increase FIO2,

• Increase CPAP or EPAP,

• adjusting IPAP with BIPAP,

• address any airway secretions

How can ventilation be improved during NIV?

• Increase the delta-P (change in pressure) by increasing the IPAP in BIPAP.

• Nebulizer therapy for bronchospasm.

What are some indicators of NIV failure?

• Worsening pH and PaCO2, Persistent tachypnea (>30 breaths/min),

• Hemodynamic instability,

• Worsening hypoxemia,

• Decreased level of consciousness,

• Inability to clear secretions,

• Inability to tolerate interface

What are the accepted SpO2 level for CPAP/NIV Weaning and Discontinuation?

SPO2 > 93%