Noninvasive Ventilation (NIV) - Practice Flashcards

Flashcards cover NIV basics, indications, equipment, settings, complications, interfaces, monitoring, and weaning considerations.

Which of the following is a negative-pressure ventilator?

Iron lung

Negative-pressure ventilators work by:

Increasing transpulmonary pressures by applying negative pressure to the chest or body

Which is a form of abdominal displacement ventilation?

Pneumobelt

In the acute care setting, what are the primary goals of NIV? (Select all that apply)

Reduce incidence of VAP; Improve patient comfort; Reduce mortality

In the chronic care setting, what is one of the main goals of NIV?

Avoid invasive ventilation

Which of the following patients would be excluded from NIV?

Hemodynamically unstable patient with ARDS

A patient presents with nocturnal hypoventilation, morning headaches, and fatigue. WhichSetting is NIV most appropriate?

Chronic care

Which humidifier type is MOST appropriate with NIV?

Heated pass-over (heated humidification)

Which of the following is TRUE about CPAP?

It aids in oxygenation only

BiPAP differs from CPAP in that:

BiPAP has IPAP and EPAP to aid in ventilation and oxygenation

What is the IBW for a male who is 5 ft 10 in tall?

Approximately 75 kg (using 50 kg + 2.3 kg × inches over 5 feet; 10 inches over → 50 + 23 ≈ 73 kg; closest option is 75 kg)

The recommended tidal volume for NIV is 6–8 mL/kg IBW. If IBW = 58 kg, what tidal volume range should you target?

348–464 mL

A patient on a nasal mask with NIV is having large air leaks through the mouth. What is the best solution?

Chin strap

During NIV, the therapist notices the exhaled VT has dropped significantly. What should be done first?

Adjust the mask/interface to reduce leaks

Which of the following complications is most likely with prolonged NIV use?

Gastric distension

Which of the following conditions is an absolute reason to terminate NIV and switch to invasive mechanical ventilation?

Patient cannot protect airway

Which setup would deliver the highest FiO₂ with portable pressure-targeted ventilator?

Leak port at mask, O₂ bleed at mask, IPAP 8, EPAP 16

Define CPAP, BiPAP, and negative-pressure ventilation (three basic NIV methods).

CPAP: continuous positive airway pressure; BiPAP: bilevel positive airway pressure with IPAP/EPAP; Negative-pressure ventilation: intermittently applies negative pressure to chest/body (iron lung, cuirass, pneumobelt)

Which type of ventilator increases lung volume by intermittently applying negative pressure to the chest?

Negative-pressure ventilator (e.g., iron lung, cuirass, pneumobelt)

True or False: Negative-pressure ventilation requires the patient to be intubated.

False

Name two examples of negative-pressure ventilators.

Iron lung; Cuirass (also pneumobelt)

What is another name for the ’shell ventilator’?

Cuirass

How does negative-pressure ventilation increase transpulmonary pressures?

By enlarging chest wall expansion via negative pressure, increasing transpulmonary pressure gradient

Which type of ventilation is known as ’iron lung therapy’?

Negative-pressure ventilation

List two drawbacks of negative-pressure ventilators compared to positive-pressure ventilators.

Bulky/less portable; limited ability to meet high ventilatory demands; (others include discomfort, skin issues)

Which type of noninvasive ventilation requires patient cooperation?

BiPAP (and NIV in general require patient cooperation)

Why might a patient need invasive ventilation instead of NIV?

Inability to protect airway or manage secretions; worsening gas exchange or hemodynamic instability

True or False: Abdominal displacement ventilation involves mechanical compression of the diaphragm.

True

What condition historically led to the widespread use of the iron lung?

Poliomyelitis (polio)

COPD patient on IPAP 8 cmH₂O and EPAP 4 cmH₂O with VT 350 mL and ABG showing CO₂ retention. Best adjustment?

Increase IPAP (e.g., to 10 cmH₂O) to raise VT

List three acute care goals of NIV.

Avoid intubation; Improve gas exchange; Reduce work of breathing (also reduce VAP and need for sedation)

How does NIV help reduce the incidence of VAP?

By avoiding endotracheal intubation

True or False: NIV often reduces the need for sedation in acute care settings.

True

Name two chronic care goals of NIV.

Prolong survival; Improve sleep quality and daytime function

How does NIV improve sleep quality in chronic hypoventilation?

By improving nocturnal gas exchange and reducing nocturnal hypoventilation

Which goal of NIV is associated with reducing mortality rates?

Prolong survival (reduced mortality)

In which setting is NIV used to improve functional residual capacity?

Chronic care setting

What is one benefit of NIV for ICU length of stay?

Can shorten ICU length of stay

How does NIV preserve physiological airway defenses compared to intubation?

By avoiding invasive airway instrumentation and preserving airway defenses

Which patient population benefits from NIV’s ability to prolong survival?

Chronic respiratory failure populations (e.g., COPD with chronic hypercapnia)

Name two ways NIV improves patient comfort.

Noninvasive interface preserves communication and eating; avoids sedation and invasive tube comfort

What is the primary indication for NIV in acute care?

Acute hypercapnic respiratory failure (e.g., COPD exacerbation) and select acute cardiogenic edema

List three clinical characteristics that may indicate NIV use.

Hypercapnic acidosis, moderate to severe dyspnea with accessory muscle use, intact airway reflexes and cooperation

Why is it important to assess disease reversibility before starting NIV?

NIV is more successful if disease is reversible; unrecoverable disease increases failure risk

True or False: Patients at high risk of NIV failure should still receive a trial.

True

Name two blood gas criteria that could support starting NIV.

Elevated PaCO₂ with acidosis; pH < 7.35 with hypercapnia

Which chronic condition often requires recognition of nocturnal hypoventilation for NIV initiation?

Obesity hypoventilation syndrome

Give two examples of restrictive thoracic diseases where NIV may be used.

Scoliosis; Kyphoscoliosis (and other chest wall deformities)

What role does patient motivation play in chronic NIV use?

Crucial for adherence and long-term success

What symptom combination suggests nocturnal hypoventilation?

Morning headaches and daytime sleepiness or fatigue

Name one objective criterion (blood gas related) used in chronic NIV initiation.

Elevated PaCO₂ with daytime hypercapnia (or ABG abnormalities)

Why is the ability to protect the airway a critical requirement for NIV?

To prevent aspiration and ensure safety if respiratory drive and airway protection are compromised

Which population is at highest risk of NIV failure: COPD, CHF, or ARDS?

ARDS (especially with hemodynamic instability)

Which condition excludes patients from NIV due to hemodynamic instability?

Hemodynamic instability/shock (unstable cardiovascular status)

True or False: ALS is a contraindication for NIV.

False

Would a patient with CAP always be excluded from NIV? Why or why not?

No; NIV can be used in select CAP patients depending on stability and risk of failure

Name two absolute contraindications for NIV.

Inability to protect airway; Inability to manage secretions or severe agitation/altered mental status

Why should NIV not be used in patients unable to handle secretions?

Risk of aspiration and inability to protect airway; increased failure risk

CPAP aids in only.

Oxygenation

BiPAP aids in both and .

Ventilation and oxygenation

True or False: CPAP is considered first-line therapy for pulmonary edema.

True

Which NIV method uses one pressure setting only?

CPAP

Which NIV method uses IPAP and EPAP?

BiPAP

Define IPAP.

Inspiratory positive airway pressure (pressure support during inspiration)

Define EPAP.

Expiratory positive airway pressure (baseline pressure during expiration)

Which setting primarily improves oxygenation?

EPAP (and FiO₂)

Which setting primarily improves ventilation?

IPAP (and inspiratory time)

Scenario: A patient on CPAP 8 cmH₂O, FiO₂ 0.80 has PaO₂ = 55 mmHg. What adjustment is appropriate?

Increase FiO₂ or consider adding higher EPAP/transition to BiPAP if needed

Scenario: A patient on BiPAP IPAP 9 / EPAP 4 still has tachypnea. What should you adjust?

Increase IPAP (increase pressure support)

Which pressure setting directly increases tidal volume on BiPAP?

IPAP

How does EPAP affect alveolar recruitment?

Higher EPAP increases alveolar recruitment and prevents collapse

What is the difference between CPAP and PEEP?

CPAP is continuous positive airway pressure for spontaneously breathing patients; PEEP is the positive pressure maintained at end expiration during ventilation

Name one clinical situation where CPAP would be preferred over BiPAP.

Cardiogenic pulmonary edema

Tidal volume delivery during BiPAP depends on which 4 factors?

IPAP, EPAP, inspiratory time, and patient effort (lung compliance/resistance)

Formula: Calculate IBW for a male, 5’8” tall.

IBW ≈ 50 kg + 2.3 kg × inches over 5 feet (5’8” = 8 in over; 50 + 18.4 ≈ 68–69 kg)

Formula: Calculate IBW for a female, 5’4” tall.

IBW ≈ 45.5 kg + 2.3 kg × inches over 5 feet (5’4” = 4 in over; 45.5 + 9.2 ≈ 54.7 kg)

If IBW = 60 kg, what is the target VT range at 6–8 mL/kg?

360–480 mL

Scenario: IPAP = 14 and EPAP = 6, what is the pressure support?

Pressure support = IPAP - EPAP = 8 cmH₂O

True or False: EPAP alone is sufficient to correct hypercapnia.

False

What is the typical initial IPAP and EPAP settings for NIV?

IPAP ~8–12 cmH₂O; EPAP ~4–6 cmH₂O

Scenario: COPD patient on IPAP 8 / EPAP 4 with PaCO₂ = 77. What’s the best action?

Increase IPAP (increase PS)

Scenario: A patient with OSA on CPAP but desats at night. What’s your next step?

Consider BiPAP or increase FiO₂ as indicated; assess for interface issues

Why is gradual adjustment of IPAP recommended instead of sudden changes?

To maintain patient comfort and synchrony and avoid ventilator asynchrony

What is the recommended maximum IPAP in most NIV protocols?

About 20 cmH₂O

Which parameter would you increase first if VT is too low?

IPAP (increase pressure support)

Scenario: BiPAP with high RR and low VT. What adjustment is needed?

Increase IPAP to raise VT

True or False: Increasing EPAP can improve oxygenation but may worsen CO₂ retention.

True

Which setting increases mean airway pressure most effectively?

EPAP

What is the most appropriate humidifier for NIV?

Heated humidifier

Why are HMEs generally not used with NIV?

They add resistance and dead space and may impair humidification

Scenario: nasal mask with severe dryness. What should you do?

Increase humidification; switch to heated humidifier

Which interface is best for minimizing leaks in mouth breathers?

Full-face mask

What intervention can reduce mouth leaks with nasal masks?

Chin strap / proper fit

True or False: Tightening mask straps is the first-line approach to stop leaks.

False

Why is patient comfort a critical factor in NIV success?

Poor comfort leads to poor adherence and failure

Name two common patient complaints with mask interfaces.

Leaks and skin breakdown (also claustrophobia, dryness)

What is the ’biggest issue’ with NIV masks according to your PPT?

Mask leaks

Why is heated humidification preferred over passive humidifiers?

Better controlled humidification and patient comfort

How should you monitor exhaled VT during NIV?

Track exhaled tidal volume with the NIV monitor and trends

Scenario: Drop in exhaled VT. First action?

Adjust the mask/interface to reduce leaks