NIV (icu)

It is intended for spontaneously breathing individuals who require mechanical ventilation:

• respiratory failure,
• chronic respiratory insufficiency,
• obstructive sleep apnea

pediatric patients weighing 20 kg (44 lb) or greater to adult patients.

intended for intubated patients meeting the same selection criteria as the noninvasive applications.

indication

CONTRINDICATION

• Lack of spontaneous respiratory drive

• Inability to maintain a patent airway or adequately clear secretions

• At risk for aspiration of gastric contents

• Acute sinusitis or otitis media

• Hypotension

contraindication

• Untreated pertussis

• Epistaxis (nosebleed)

summray of EBP

NIV reduces intubation rate and mortality in COPD patients with decompensated respiratory acidosis

Reduction in the need for ICU

Reduced hospital costs compared to standard medical therapy.

Mortality rates are reduced by approximately 50%

EBP

complication

ear discomfort, conjunctivitis, skin abrasions due to mask/patient interface, and gastric distention (aerophagia).

chest discomfort, shortness of breath, or severe headache.

complication

What can go wrong with NIV

Asynchrony between Patient and ventilator

Hypocapnia/Alkalosis

Difficulty inflating the chest

Nasal Problems

Gastric distension

Persistent hypoxaemia

Non co-operation/ aggressive behaviour

Be alert

Persistently elevated PaCO2

Increase EPAP to decrease the potential for CO2 rebreathing.

Higher pressures produce more flow through the exhalation port, which helps to purge all CO2 from the circuit to prevent rebreathing.

• Be aware that the potential for CO2 rebreathing increases as inspiratory time increases.

A longer inspiratory time decreases exhalation time, allowing less CO2 to be purged from the circuit before the next cycle.

In such circumstances, higher tidal volumes further increase the volume of CO2 rebreathed by the patient.

hypercapina

What to monitor during NIV

• A mixture of physiological measures and clinical assessment parameters

• Continuous pulse oximetry monitoring for the first 12 hours and respiratory rate, pulse, blood pressure and assessments of consciousness regularly.

• Arterial blood gases should be taken as a minimum at 1, 4 and 12 hours after the initiation of NIV

• These should be used to assist in both formulating a management plan and, within the first 4 hours of NIV, the decision as to the appropriateness of escalating to intubation

• Compliance with NIV, patient-ventilator synchrony and mask comfort are key factors in determining outcome and should be checked regularly

Monitoring

Advantage

Advantage

BIPAP: Bi-level Positive Airway Pressure

S/T mode ?

BIPAP

CPAP: Continuous Positive Airway Pressure

CPAP

PCV

The PCV (pressure-controlled ventilation) mode delivers pressure-controlled mandatory breaths, either triggered by the ventilator (Timed) or the patient (Spont). You set no triggering sensitivity: the patient trigger is based on the ventilator’s Auto-Trak Sensitivity algorithms.

Others

AVAPS

(average volume-assured pressure support) mode delivers a target tidal volume. It achieves the target volume by regulating the pressure applied following an initial pressure ramp-up. The AVAPS mode delivers time-cycled mandatory breaths and pressure-supported spontaneous breaths.

Parameters and ABG

Humidification during NIV

Both water humidification and dry humidification can be used

Humidification is highly recommended for obvious reasons

Dry humidification (HME) might increase resistance and May be less effective with MV of greater than 15 l/m

hudimification