Scribd
Upload
16 views19 pages

Niv Basics

Non-invasive ventilation (NIV) provides ventilatory support through a mask to improve gas exchange and avoid intubation in patients with respiratory failure. It is initiated based on specific criteria and involves careful monitoring and adjustment of settings to ensure patient comfort and effectiveness. The document also outlines when to initiate or avoid NIV, necessary equipment, and troubleshooting tips for common issues.

Uploaded by

rtalnahdha
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
16 views19 pages

Niv Basics

Non-invasive ventilation (NIV) provides ventilatory support through a mask to improve gas exchange and avoid intubation in patients with respiratory failure. It is initiated based on specific criteria and involves careful monitoring and adjustment of settings to ensure patient comfort and effectiveness. The document also outlines when to initiate or avoid NIV, necessary equipment, and troubleshooting tips for common issues.

Uploaded by

rtalnahdha
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 19

Basics of Non Invassive

Ventilation
By
RT-Arunkumar kanagaraj
Definition

 Non-invasive ventilation (NIV) refers to the


provision of ventilatory support through the
patient's upper airway using a mask or
similar device
Goals of Noninvasive Ventilation

ACUTE CARE SETTING


 • Improve gas exchange
 • Avoid intubation
 • Decrease mortality
 • Decrease length of time on ventilator
 • Decrease length of hospitalization
 • Decrease incidence of ventilator-associated pneumonia
 • Relieve symptoms of respiratory distress
 • Improve patient-ventilator synchrony
 • Maximize patient comfort
 LONG-TERM CARE SETTING
 • Relieve or improve symptoms
 • Enhance quality of life
 • Avoid hospitalization
 • Increase survival
 • Improve mobility
NIV-When to initiate?
Criteria for Patients With Acute
 Respiratory Failure
 Two or more of the following should be
present:
 • Use of accessory muscles
 • Paradoxical breathing
 • Respiratory rate ≥25 breaths/min
 • Moderate to severe dyspnea (increased
dyspnea in COPD patients)
 • PaCO2 >45 mm Hg with pH <7.35
 • PaO2/FIO2 ratio <200
ACUTE CONDITIONS
 • Hypercapnic respiratory failure
 • COPD exacerbation
 • Asthma
 • Facilitation of extubation, especially in COPD
 • Hypoxemic respiratory failure but cautiously
 • Acute cardiogenic pulmonary edema
 • Respiratory failure in immunocompromised patients
 • End-of-life care and DNI orders
 • Postoperative respiratory failure
 • Prevention of reintubation in high-risk patients
 • Postextubation respiratory failure
CHRONIC CONDITIONS
 • Nocturnal hypoventilation
 • Restrictive thoracic disease
 • ALS
 • COPD
 • OHS
NIV –When not to initiate?
 Respiratory arrest
 Medically unstable
 Unable to protect airway
 Excessive secretions
 Uncooperative or agitated
 Unable to fit mask
 Recent upper airway or gastrointestinal surgery
 Severe air trapping
 Suspected barotraumas
 Pneumothorax
 Severe Hypotension
 Severe Cardiac Arrhythmia
 Diminished consciousness with inability to protect airway
 Allergic reaction to mask
 Vomiting and Nausea
Equipment Needed:

 BiPAP / CPAP unit with power cord


 Single Use Disposable Circuit
 Full face mask ( small for female, medium and
large for male)
 Head Strape
 Humidifier (optional)
Mode Selection

 There are two types of modes:

BIPAP : Bi Level Positive airway pressure

CPAP : Continuos Positive Airway Pressure


SETTINGS
 BIPAP settings:
IPAP
EPAP
FIO2
RR
I:E RATIO

• CPAP settings:
FIO2
PEEP = CPAP = EPAP
Initiation of NIV:
 Place patient in an upright or sitting position.
 Carefully explain the procedure for noninvasive positive pressure
ventilation, including the goals and possible complications.
 Using a sizing gauge, make sure a mask is chosen that is the proper size
and fit.
 Attach the interface and circuit to the ventilator or NIV machine. Turn on
the ventilator and adjust it initially to low pressure setting.
 Hold or allow the patient to hold the mask gently to the face until the
patient becomes comfortable with it. Encourage the patient to use proper
breathing technique.
 Monitor oxygen (O2) saturation; adjust the fractional inspired oxygen (FiO2)
to maintain O2 saturation; above 90%.
 Secure the mask to the patient. Do not make the straps too tight.
 Titrate the inspiratory and end-expiratory positive airway pressures (IPAP
and EPAP) to achieve patient comfort, adequate exhaled tidal volume, and
synchrony with the ventilator. Do not allow peak pressures to exceed 20
cm H2O.
 Check for leaks and adjust the Straps if necessary
 Monitor the respiratory rate, heart rate, level of dyspnea, O2 saturation,
minute ventilation, and exhaled tidal volume.
 Obtain blood gas values within 1 hour.
Monitor Therapy Goals
 Does patient demonstrate significant
improvement in ABG’s and respiratory
symptoms?
 Is patient stabilized?
 Transfer stabilized patient to Unit /Floor
 If patient shows no improvement after 1 hour
elapsed, advise physician
 that patient’s current respiratory status may
warrant the physician
 Considering intubation and placement of the
patient on mechanical ventilation
Monitoring the patient on NIV
 SpO2 - continuous monitoring with pulse
oximeter.
 ABGs - 1 hour post commencement of NIV,
thereafter evaluate as per patient's condition (if
ABGs worsening after 4-6 hours then this is a
poor prognostic factor for NIV).
 Heart rate and Respiratory rate.
 Evaluate accessory muscle use.
 Chest wall movement (to ensure adequate
ventilation).
 Synchrony with the ventilator and air leaks
WEANING CRITERIA
 Is the patient ready to wean?
 Clinically stable for >6 hours
 RR <24bpm
 HR <110bpm
 SpO2 >88% on 4L O2 on NIV
 If 'NO' to the above:
 Continuous NIV (monitor as before)
 If 'YES' to the above:
 Allow breaks for meals, medication, physiotherapy etc
 Consider nocturnal NIV only
 Controlled O2 therapy
 If worsening respiratory distress, reassess patient,
review therapy and consider recommencing NIV
Troubleshooting
Type of Alarm Cause How to correct
Low Tidal Volume/Low Minute Disconnection/Leaks around Proper fitting of mask
volume the mask/improper mask size Appropriate selection of mask

High Tidal Volume/High Tidal High Flow Rate/ Reduce the IPAP /Motivate the
Volume Tachypnea/Agitation patient

Apnea Inappropriate Triggering/Low Check the sensitivity/


backup rate Increase backup RR

Low Circuit Leak Inadequate Exhalation Enhance exhalation through


trachael connector or mask
side exhalation port
Low Battery Electrical Circuit Check the Power cord is
Disconnection properly placed or rectify
power sources are working
correctly
High respiratory rate Inadequate Flow rate or Increase the IPAP and reduce
worsening Respiratory the inspiratory Time
distress
 Thank You

You might also like