2. 2
NIV is now considered a standard of care of selected
patients with acute respiratory failure; reducing the need
for intubation with INV-MV and related complications,
reducing mortality rates, and shortening of hospital stay
3. 3
In modern ICU care, NIV is used
frequently for the care of patients
with acute respiratory failure,
without intubation and invasive MV
and related complications like use of
sedation/NMBAs, ICU-acquired
weakness, VAP/VILI, or DVT-VTE
events
With appropriate machine setting
and cases selection, NIV is
associated with improved pulmonary
mechanics and Vent/Oxyg plus
reduced WOB
12. 12
Criteria of FITNESS for NIV
Respiratory not severe exhaustion nor impending arrest, Cardiovascular
hemodynamic stability, and Neurologic intact drive and AW protection plus
adequate cognition and consciousness
13. 13
EXCLUSION Criteria for NIV
Respiratory severe exhaustion and secretions or impending arrest,
Cardiovascular hemodynamic instability, Neurologic impaired drive and AW
protection plus impaired cognition and consciousness, and Interface facial or
upper GI disorders
14. 14
SUCCESS Criteria for NIV
Respiratory comfortable and relieved distress with RR < 25 b/m, and SaO2 ≥
90% with PaO2/FiO2 > 200 plus PaCO2 < 50 mmHg and pH > 7.30,
Cardiovascular hemodynamic stability, Neurologic intact drive and AW
protection plus adequate cognition and consciousness
Weaning HFNC
15. 15
TERMINATION Criteria for NIV
Respiratory severe exhaustion or impending arrest, Cardiovascular
hemodynamic instability, Neurologic impaired drive and AW protection plus
impaired cognition and consciousness, and NIV Failure uncomfortable with
distress with RR > 35 b/m, and hypoxia SaO2 < 88% with PaO2/FiO2 < 150, plus
hypercapnia with worsening PaCO2 or > 60 mmHg and pH < 7.25, or severe
pulmonary NIV Complications
Intubation
INV-MV
16. 16
Modes of NIV
Constant AW pressure through the
cycle of spontaneous breathing
CPAP
Bi-level CPAP as inspiratory level
is higher than expiratory level
BiPAP
Inspiratory level is supported by
PS and expiratory baseline is PEEP
PSV/PEEP
PSV/PEEP or BiPAP breathing
delivery with guaranteed preset
tidal volume level
A-VAPS
Method of Administration
It may be continuous for few hours until
improvement, or periodic on/off sessions
for few days
17. 17
Steps for Initiating NIV
The proper mode and interface
Choose
The patient in upright or sitting position
Place
The procedure goals and complications
Explain
NIV with initial low pressure settings
Adjust
The mask over the patient face; make it
comfortable/gentle/secured/no leakage
Strap
The patient to breath in a proper pattern
Encourage
The patient for fighting or tolerance
Observe
The patient; clinical (reduced WOB and
LOC plus HD status), ABG (SaO2 plus
PaO2/FiO2 and PaCo2 with pH), and NIV
graphs (Vt/RR/MV/pressures)
Monitor
or of FiO2 and pressures accordingly
Readjust
NIV goals and complications
Monitor
Termination and intubation and INV-MV
Failure
Consider weaning and shift to COT
Success
Periodic on/off trials or step-wise
decrements in IPAP and PSV values
Weaning
18. 18
Good for hypoxia
One level of PAP during spontaneous breathing; value of
Vt/RR/Ti are dependent on the patient drive/effort
Increased FRC, alveolar recruitment, and improved VQ
matching
CPAP
CPAP spontaneous breathing with PS to inspiration to
augment Vt delivery and reduce WOB
PSV &
PEEP
Good for hypoxia
and hypercapnia
Tow levels of PAP with spontaneous breathing through
these tow levels; cycling between IPAP and EPAP is
dependent on preset Ti
IPAP (similar to PIP) alveolar ventilation by Vt and
minute ventilation according to patient drive/effort
improved CO2 washing and reduction of WOB
EPAP (similar to PEEP) alveolar recruitment and
increased FRC improved oxygenation and VQ
matching
BiPAP
NIV PSV or BiPAP with guaranteeing of preset Vt; level
of PSV or IPAP is automatically adjusted to deliver the
preset Vt
VAPS
21. 21
FiO2 initial 100% then to < 50%, PSV
initial 5-10 cmH2O and gradual to 20
cmH2O, and PEEP 5-10 cmH2O; to
achieve adequate MV and PaCO2 and
SaO2, keeping RR ≤ 25 b/m and Vt 6-8
ml/kg PBW
22. 22
FiO2 initial 100% then to < 60%, plus
IPAP (Vent) 10-25 cmH2O and EPAP
(Oxyg) 5-15 cmH2O; achieve adequate
MV and PaCO2 and SaO2, keeping
RR ≤ 25 b/m and Vt 6-8 ml/kg PBW
