8. “The delivery of mechanical ventilation to the lungs
using techniques that do not require endotracheal
intubation”
9. Initially used in the treatment of hypoventilation
with Neuromuscular Disease
Now accepted modality in treatment of acute
respiratory failure
10. Respiratory effort required for inspiration needs to
overcome
◦ Elastic work (stretch)
◦ Flow resistance work ( airway obstruction)
Respiratory failure – forces opposing inspiration
exceed respiratory muscle effort
11. Failure to maintain adequate gas exchange
Hypoxic ( Type 1)
or
Hypercapnic /Hypoxic (Type 2)
Acute /Chronic / Acute on Chronic
12. Improves alveolar ventilation to reverse
respiratory acidosis and hypercarbia
Recruits alveoli and increases FRC to reverse
hypoxia
Reduces work of breathing
13.
14. Noninvasiveness
Application - easy to implement or remove
Improves patient comfort
Reduces the need for sedation
Oral patency
(preserves speech, swallowing, and cough)
15. Avoid the resistive work of ETT
Avoids the complications of ETT
◦ Early (local trauma, aspiration)
◦ Late (injury to the the hypopharynx, larynx, and trachea,
nosocomial infections)
Reduced Cost and Length of Stay
16. 1.System
Slower correction of gas exchange abnormalities
Gastric distension (occurs in <2% patients)
2.Mask
Air leakage
Eye irritation
Facial skin necrosis (most common complication)
17. 3.Lack of airway access and protection
Suctioning of secretions
Aspiration
4. Compliance / claustrophobia
5. Work load and supervision
18.
19. Hypoxaemia = CPAP
Hypercapnia and hypoxaemia= Bi Level
20. CONTINUOUS POSITIVE AIRWAY PRESSURE (AKA
PEEP)
Constant positive airway pressure throughout cycle
Improves oxygenation
Decreases work of breathing by alveolar recruitment
(Dec elastic work) and unloads insp muscles
Decreases hypoxia by alveolar recruitment and
reduces intrapulmonary shunt
29. Hypoxia
Pulmonary barotrauma
Reduced cardiac output
Vomiting and aspiration
Pressure areas
Gastric distension
30.
31. • CPAP at 5-8 and increase to 10-15 cm H20
• Mask is held gently on patient’s face.
• Increase the pressures until adequate Vt (7ml/kg),
RR<25/min, and patient comfortable.
• Titrate FiO2 to achieve SpO2>90%.
• Keep peak pressure <25-30 cm
32. increases pH, reduces PaCO2, reduces the
severity of breathlessness in first 4 h of treatment
decreases the length of hospital stay
mortality and intubation rates are reduced
33. • Mode- Spontaneous/Timed
• EPAP- 4-5 cm H20 IPAP- 12- 15 cm H20
• Trigger- maximum sensitivity
• Back up rate- 15 breaths/min
• Back up I:E 1:3
34. No contraindications
O2 medical therapy underway
Explanation and reassurance
Correct mask size
Ventilator set up
Commence NIV hold mask in place
Reassure and fix mask
Monitor and observe, regular assessment
35. Physiological
a) Continuous oximetry
b) Exhaled tidal volume
c) ABG- Initial, 1, 2-6 hrs
Objective
a) Respiratory rate
b) Chest wall movement
c) Coordination of respiratory effort with NIV
d) Accessory muscle use
e) HR and BP
f) Mental state
Subjective
a) Dyspnoea
b) Comfort
36. Mode of ventilation
Flow rate of oxygen, percentage of oxygen
TPR and BP
Respiratory assessment
Conscious level (GCS)
Obs - 15 minutely for first hour, then hourly if condition stable
37. Deterioration in condition
Worsening or non improving ABG
Intolerance or failure to coordinate with machine
38. Back to the patient- ABC
Medical therapy optimised
Treatment of complications
39. • Inability to tolerate the mask
• Inability to improve gas exchange or dyspnoea
• Need for endotracheal intubation
• Hemodynamic instability
• ECG – ischaemia/arrhythmia
41. Selection of patient really vital to success - need
to have reversible pathology
Aim for gradual improvement over hours with
good supportive nursing
In ED, main use is to avoid intubation / ventilation
in LVF and COAD
