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REFERENCES

Medical treatment-

20% mortality rate

NIV-

10% Mortality rate

  • NO sedation or anesthesia
  • Patient has an active Respiratory drive and is able to breathe spontaneously.
  • Less complications
  • patient can remain conscious
  • Patient tolerance
  • unmanaged airway
  • risk of aspiration
  • leak
  • Pressure injuries
  • gastric distention
  • corneal irritation

PRO'S

Plant P, Owen J, Elliott M (2000). A multicentre randomised controlled trial of the early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. Lancet 355:1931–1935, .

CON'S

Exclusion Criteria

BROCHARD, L. (2000). Non-invasive ventilation for acute exacerbations of COPD: a new standard of care. Thorax, 55(10), pp.817-818.

%

  • Unconscious
  • compromised airway or obstruction
  • vomiting
  • chest wall trauma
  • pneumothorax
  • non compliant
  • sever haemodynamic instability
  • facial trauma

Sa02=

RR=

who should receive NIV

Acute exacerbations of COPD

Type 2 respiratory

failure

Hypercapnia

Mild - moderate

respiratory Acidosis

Mydin, H., Murphy, S. and Antunes, G. (2011). Acidosis, non-invasive ventilation and mortality in hospitalised COPD exacerbations. Thorax, 67(1), pp.82-82.

Babu, K. (2003). Non-invasive ventilation in chronic obstructive pulmonary disease. BMJ, 326(7382), pp.177-178.

Sarinc Ulasli, S. and Esquinas, A. (2016). Walking with Only Non-Invasive Ventilation in Stable Hypercapnic COPD Patients: Sufficient or Not?. COPD: Journal of Chronic Obstructive Pulmonary Disease, pp.1-2.

What is NIV?

  • positive pressure ventilation
  • Spontaneously breathing patients
  • First line treatment

BiPAP

CPAP

Continuous Positive Airway Pressure

Bilevel Positive Airway Pressure

  • Is CPAP with pressure support
  • set PEEP (EPAP)
  • set IPAP
  • Set PEEP
  • No pressure support

IPAP

EPAP

Expiratory positive airway pressure

or PEEP

Inspiratory positive airway pressure

  • extra/ added pressure on top of EPAP during inspiration

cmH20

Pressure support =

7cmH20

IPAP 12

=PS

5

EPAP

Escalation of care

Weaning NIV

Spontaneous breathing

WOB remains unchanged or increases

Pt is stable

worsening acidosis

Pt is able to speak in full sentences

Failure to tolerate BiPAP

Not requiring high Fi02

Non Invasive Ventilation (NIV) in COPD

decrease in GCS

Sp02 within desired range for patient

Pt becomes haemodynamically unstable

unresolved hypoxia

pH, C02 and PO2 within normal range for patient

Commenced as early as possible

Best practice for NIV delivery:

Intensive Care Unit

mask fitted appropriately

titrate IPAP, EPAP and FiO2

Patient education and reassurance

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