Non-invasive ventilation (NIV) is the use of breathing support administered through a face mask or nasal mask. Learn more about NIV in this presentation by Dr Somnath Longani, consultant Anaesthesiologist & Intensivist, Midland Healthcare & Research Center, lucknow
https://midlandhealthcare.org/
Final newer modes and facts niv chandanChandan Sheet
THIS IS THE BASIC POINTS REGARDING NIV, THIS IS COMPILED AND ARRANGED FROM DIFFERENT BOOKS, JOURNALS AND PPTs.
The author is grateful to the teachers and authors of pulmonology and critical care.
APRV (Airway Pressure Release Ventilation) is a ventilation mode that applies continuous positive airway pressure (CPAP) for a prolonged high-pressure phase (T high) to recruit and maintain lung volume. It then has a brief low-pressure release phase (T low) where most ventilation and CO2 removal occurs. Compared to conventional ventilation, APRV may cause less ventilator-induced lung injury due to maintaining higher end-expiratory lung volumes without repetitive opening/closing of alveoli. It also allows for spontaneous breathing which improves patient comfort and outcomes. While APRV does not reduce mortality, it can improve other outcomes such as shorter ventilation times and ICU stays.
This document provides an overview of non-invasive ventilation (NIV). It discusses the history of NIV, types of ventilators and modes used, interfaces, indications and contraindications. Guidelines are provided on how to start and monitor NIV, including adjusting settings based on patient response. Advantages, disadvantages and complications of NIV are reviewed. Applications of NIV for specific clinical conditions like COPD exacerbation and acute cardiogenic pulmonary edema are covered. The document aims to educate medical professionals on best practices for administering and monitoring patients receiving NIV treatment.
This document discusses several advanced modes of mechanical ventilation. It begins by describing triggered modes like volume support (VS) and proportional assist ventilation (PAV) which provide pressure support that varies based on patient effort. It then covers hybrid modes like volume-assured pressure support and pressure regulated volume control (PRVC) which use dual controls. Newer dual-controlled modes are presented that regulate pressure and volume both within and between breaths. Modes like adaptive support ventilation (ASV) automatically adapt settings to patient changes. Pros, cons and indications are provided for some of the more complex modes.
The document discusses various ventilator settings including tidal volume, minute ventilation, peak inspiratory pressure, positive end-expiratory pressure, inspiratory-to-expiratory ratios, and modes of ventilation such as pressure control, volume control, assisted ventilation and spontaneous breathing modes. It provides details on anatomy of the ventilator, how to start a ventilator, and disease-based strategies for setting appropriate ventilation parameters for conditions like normal lung, CNS pathology, parenchymal lung disease, and airway diseases.
This document provides an overview of mechanical ventilation, including:
1) How mechanical ventilation helps reduce the work of breathing and restore gas exchange through invasive and noninvasive positive pressure ventilation.
2) The basics of monitoring pressure, volume, flow, and pressure-time curves at the bedside.
3) Important considerations for mechanical ventilation including potential adverse effects on hemodynamics, lungs, and gas exchange, and how to address issues like auto-PEEP.
Final newer modes and facts niv chandanChandan Sheet
THIS IS THE BASIC POINTS REGARDING NIV, THIS IS COMPILED AND ARRANGED FROM DIFFERENT BOOKS, JOURNALS AND PPTs.
The author is grateful to the teachers and authors of pulmonology and critical care.
APRV (Airway Pressure Release Ventilation) is a ventilation mode that applies continuous positive airway pressure (CPAP) for a prolonged high-pressure phase (T high) to recruit and maintain lung volume. It then has a brief low-pressure release phase (T low) where most ventilation and CO2 removal occurs. Compared to conventional ventilation, APRV may cause less ventilator-induced lung injury due to maintaining higher end-expiratory lung volumes without repetitive opening/closing of alveoli. It also allows for spontaneous breathing which improves patient comfort and outcomes. While APRV does not reduce mortality, it can improve other outcomes such as shorter ventilation times and ICU stays.
This document provides an overview of non-invasive ventilation (NIV). It discusses the history of NIV, types of ventilators and modes used, interfaces, indications and contraindications. Guidelines are provided on how to start and monitor NIV, including adjusting settings based on patient response. Advantages, disadvantages and complications of NIV are reviewed. Applications of NIV for specific clinical conditions like COPD exacerbation and acute cardiogenic pulmonary edema are covered. The document aims to educate medical professionals on best practices for administering and monitoring patients receiving NIV treatment.
This document discusses several advanced modes of mechanical ventilation. It begins by describing triggered modes like volume support (VS) and proportional assist ventilation (PAV) which provide pressure support that varies based on patient effort. It then covers hybrid modes like volume-assured pressure support and pressure regulated volume control (PRVC) which use dual controls. Newer dual-controlled modes are presented that regulate pressure and volume both within and between breaths. Modes like adaptive support ventilation (ASV) automatically adapt settings to patient changes. Pros, cons and indications are provided for some of the more complex modes.
The document discusses various ventilator settings including tidal volume, minute ventilation, peak inspiratory pressure, positive end-expiratory pressure, inspiratory-to-expiratory ratios, and modes of ventilation such as pressure control, volume control, assisted ventilation and spontaneous breathing modes. It provides details on anatomy of the ventilator, how to start a ventilator, and disease-based strategies for setting appropriate ventilation parameters for conditions like normal lung, CNS pathology, parenchymal lung disease, and airway diseases.
This document provides an overview of mechanical ventilation, including:
1) How mechanical ventilation helps reduce the work of breathing and restore gas exchange through invasive and noninvasive positive pressure ventilation.
2) The basics of monitoring pressure, volume, flow, and pressure-time curves at the bedside.
3) Important considerations for mechanical ventilation including potential adverse effects on hemodynamics, lungs, and gas exchange, and how to address issues like auto-PEEP.
This document discusses ventilator settings and modes. It begins by defining a ventilator and listing some key settings such as respiratory rate, tidal volume, minute ventilation, fraction of inspired oxygen, and positive end expiratory pressure. It then discusses the different types of ventilator modes: controlled modes (e.g. volume control, pressure control), supported modes (e.g. pressure support), and combination modes (e.g. SIMV with pressure support). The document concludes by outlining the steps for assessing a patient's readiness for weaning from the ventilator and describing methods for weaning such as a spontaneous breathing trial.
PRVC (Pressure Regulated Volume Control) is a mode of mechanical ventilation that uses pressure control adjusted breath-to-breath to deliver a set tidal volume. It sets a minimum respiratory rate, target tidal volume, and maximum pressure limit. The ventilator measures the tidal volume on each breath and adjusts the inspiratory pressure up or down as needed to try and deliver the set tidal volume with each subsequent breath. This allows the ventilator to compensate for changes in lung compliance to help guarantee tidal volume delivery while limiting pressures. However, tidal volumes can still vary with intermittent patient effort.
Noninvasive ventilation (NIV) refers to ventilatory support without an invasive artificial airway such as an endotracheal or tracheostomy tube. NIV can be delivered via nasal or oronasal masks connected to positive pressure ventilators. The document traces the history of ventilation from ancient times to modern NIV techniques. It describes various interfaces, modes of ventilation including CPAP, contraindications, and suitable clinical conditions for NIV support such as COPD exacerbations and cardiac pulmonary edema.
Mechanical Ventilation (MV) is almost always a challenging topic for ICU nurses and practitioners. In this presentation we are going to review and relearn basics of MV together.
Non invasive ventilation for nurses-dr Shahna Ali,JNMC,AMUShahnaali
Non-invasive ventilation (NIV) delivers mechanical ventilation without an endotracheal tube. It is used for acute or chronic respiratory failure. NIV uses interfaces like masks to deliver bilevel positive airway pressure (BiPAP). It has advantages over invasive ventilation like avoiding complications of intubation and allowing oral communication. Selection criteria, monitoring, interfaces, modes and settings are described. NIV is assessed for improvement in blood gases and symptoms. Weaning involves gradually decreasing pressure support. NIV may need to be changed to invasive ventilation if a patient deteriorates on NIV.
1) Ventilator graphics display waveforms that facilitate assessment of a patient's condition on mechanical ventilation. The most commonly used graphics are scalars (flow vs time, pressure vs time, volume vs time) and loops (pressure-volume, flow-volume).
2) Scalar graphics show the relationship between flow, volume, or pressure over time. Loops show the relationship between pressure and volume or flow and volume. These graphics provide information about ventilator settings, lung mechanics, and the identification of common issues like airway obstruction or air trapping.
3) Proper analysis of ventilator graphics is essential for optimizing ventilator settings and recognizing abnormalities that may require intervention to improve a patient's ventilation
1) Recruitment maneuvers (RMs) aim to reopen collapsed alveoli in ARDS patients through temporarily increasing transpulmonary pressure. Common types include sighs, sustained inflations, and stepwise increases in pressure.
2) While RMs often improve short-term oxygenation, clinical trials have found no evidence of reduced mortality or improved outcomes. One large trial found RMs may actually increase mortality.
3) Not all ARDS patients respond equally to RMs due to factors like etiology, severity, and lung recruitability. RMs should only be considered for hypoxemic individuals based on an individual risk-benefit assessment.
Non-invasive ventilation (NIV) provides ventilatory support without intubation through a non-invasive interface like a mask. It is used initially to treat type 2 respiratory failure and prevent need for mechanical ventilation. Benefits include avoiding complications of intubation and improving outcomes by reducing mortality, morbidity, ICU/hospital stay, and costs. NIV is appropriate for patients with acute or acute on chronic respiratory failure who are cooperative, hemodynamically stable, and have an adequate cough reflex. Factors determining success include careful patient selection, skilled application and monitoring, and timely transition to invasive ventilation if needed.
This document provides an overview of ventilator basics and parameters including:
1) It describes the basic components and parameters of ventilators such as modes, controls, triggers and adjunct therapies.
2) It explains some common ventilator modes like pressure control ventilation, BiPAP, and APRV and notes some safety considerations.
3) It outlines potential complications from mechanical ventilation and stresses the importance of monitoring patients and equipment.
This document provides information on non-invasive ventilation (NIV) including:
1. The physiologic effects of positive pressure ventilation such as increased laminar flow and alveolar recruitment.
2. Contraindications and types of respiratory failure and their management approaches. BiPAP is used for hypercapnic failure with acidosis while CPAP is used for acute hypoxia.
3. Guidelines for setting pressures on CPAP and BiPAP and troubleshooting persistent hypoxia or hypercapnia by adjusting pressures.
4. Early predictors of NIV failure including a pH <7.3 and lack of acute worsening of chronic respiratory failure.
5. Clinical vignettes describing
The document discusses basic principles of mechanical ventilation including factors that can lead to ventilatory failure, airway resistance, lung compliance, hypoventilation, V/Q mismatch, intrapulmonary shunting, and diffusion defects. It also covers different types of ventilator waveforms including pressure, volume, flow and pressure/volume loops which can be used to assess a patient's respiratory status and response to therapy.
APRV is a ventilation mode that applies CPAP at a high pressure for a prolonged period of time to recruit and maintain lung volume, followed by brief releases to a lower pressure to allow for exhalation and CO2 removal. It aims to preserve spontaneous breathing. APRV is indicated for ARDS management and postoperative atelectasis and has benefits like improved oxygenation and reduced sedation needs but risks include increased work of breathing and worsening of air leaks. Studies comparing APRV to other modes in ARDS patients have found similar outcomes but more research is still needed to determine its full utility.
Noninvasive ventilation (NIV) delivers ventilatory support without an invasive airway. It works by reducing inspiratory muscle work and avoiding fatigue. NIV improves lung compliance and gas exchange while allowing oral intake and speech. The main advantages of NIV are that it is noninvasive and avoids complications of intubation. Potential disadvantages include slower correction of abnormalities and issues with masks like leaks or skin damage. NIV can be administered in emergency departments or wards by trained staff and is used to treat conditions like COPD exacerbations, cardiogenic pulmonary edema, and post-extubation respiratory failure.
The document discusses ventilation and different modes of noninvasive ventilation. It provides details on:
1) How ventilation works through pressure differences that cause air to flow into and out of the lungs. Different factors like resistance and Boyle's law impact this process.
2) The history and development of noninvasive ventilation, from early negative pressure devices to current use of positive pressure ventilation delivered noninvasively through masks.
3) Modes of noninvasive positive pressure ventilation including volume ventilation, pressure ventilation, bilevel PAP, and CPAP. The benefits and limitations of noninvasive ventilation are also summarized.
This document provides an overview of mechanical ventilation including definitions, modes, settings, and management. It discusses non-invasive ventilation techniques like CPAP and BiPAP as well as various modes of invasive ventilation such as CMV, SIMV, and pressure support. Key variables, advantages, and disadvantages of different modes are explained. Graphs are presented to illustrate concepts like PEEP, auto-PEEP, and the relationship between pressure and volume ventilation. Management considerations for various disease states are also covered.
this is compiled & created to discuss the basic modes and initiation of NIV
the author is thankful to the previous authors,teachers who helped to conceptualize the NIV .
This document provides an overview of non-invasive ventilation (NIV), including its definition, historical background, mechanisms of action, indications and contraindications, different modes (CPAP vs BiPAP), and evidence supporting its use. Key points include that NIV avoids intubation and its complications, evidence shows benefits for COPD exacerbations and cardiogenic pulmonary edema, and both CPAP and BiPAP can effectively treat acute cardiogenic pulmonary edema with no differences in patient outcomes.
The document discusses several newer modes of mechanical ventilation including volume assured pressure support (VAPS), volume support (VS), pressure regulated volume control (PRVC), and adaptive support ventilation (ASV). VAPS switches between pressure control and volume control modes within a breath to ensure a minimum tidal volume. VS adjusts pressure support levels between breaths to maintain a target tidal volume. PRVC aims to deliver a set tidal volume with the lowest possible airway pressure by modifying flow and time. ASV automatically adapts support levels to provide a minimum minute ventilation with the least work of breathing.
The document discusses various techniques for invasive and non-invasive neonatal ventilation. It describes conventional mechanical ventilation modes like CMV, IMV, SIMV and newer modes like pressure support ventilation and proportional assist ventilation. It also covers high frequency ventilation, CPAP and newer non-invasive techniques like NIPPV and SNIPPV which aim to provide respiratory support without intubation. The goals, mechanisms, settings and potential complications of different ventilation strategies are outlined.
Mechanical ventilators generate a controlled flow of gas into a patient's airways using various modes of ventilation. There are both positive and negative pressure machines that can be either invasive or non-invasive. Modes include volume cycled, pressure cycled, time cycled, and flow cycled. Ventilators aim to provide oxygenation through settings like FIO2 and PEEP, and ventilation through tidal volume and respiratory rate. They are indicated for conditions causing respiratory failure and can have complications like lung injury, infection, and decreased blood pressure. Settings must be adjusted based on blood gas results and the patient's condition. Weaning involves gradually reducing support as the patient improves. Non-invasive ventilation
This document discusses ventilator settings and modes. It begins by defining a ventilator and listing some key settings such as respiratory rate, tidal volume, minute ventilation, fraction of inspired oxygen, and positive end expiratory pressure. It then discusses the different types of ventilator modes: controlled modes (e.g. volume control, pressure control), supported modes (e.g. pressure support), and combination modes (e.g. SIMV with pressure support). The document concludes by outlining the steps for assessing a patient's readiness for weaning from the ventilator and describing methods for weaning such as a spontaneous breathing trial.
PRVC (Pressure Regulated Volume Control) is a mode of mechanical ventilation that uses pressure control adjusted breath-to-breath to deliver a set tidal volume. It sets a minimum respiratory rate, target tidal volume, and maximum pressure limit. The ventilator measures the tidal volume on each breath and adjusts the inspiratory pressure up or down as needed to try and deliver the set tidal volume with each subsequent breath. This allows the ventilator to compensate for changes in lung compliance to help guarantee tidal volume delivery while limiting pressures. However, tidal volumes can still vary with intermittent patient effort.
Noninvasive ventilation (NIV) refers to ventilatory support without an invasive artificial airway such as an endotracheal or tracheostomy tube. NIV can be delivered via nasal or oronasal masks connected to positive pressure ventilators. The document traces the history of ventilation from ancient times to modern NIV techniques. It describes various interfaces, modes of ventilation including CPAP, contraindications, and suitable clinical conditions for NIV support such as COPD exacerbations and cardiac pulmonary edema.
Mechanical Ventilation (MV) is almost always a challenging topic for ICU nurses and practitioners. In this presentation we are going to review and relearn basics of MV together.
Non invasive ventilation for nurses-dr Shahna Ali,JNMC,AMUShahnaali
Non-invasive ventilation (NIV) delivers mechanical ventilation without an endotracheal tube. It is used for acute or chronic respiratory failure. NIV uses interfaces like masks to deliver bilevel positive airway pressure (BiPAP). It has advantages over invasive ventilation like avoiding complications of intubation and allowing oral communication. Selection criteria, monitoring, interfaces, modes and settings are described. NIV is assessed for improvement in blood gases and symptoms. Weaning involves gradually decreasing pressure support. NIV may need to be changed to invasive ventilation if a patient deteriorates on NIV.
1) Ventilator graphics display waveforms that facilitate assessment of a patient's condition on mechanical ventilation. The most commonly used graphics are scalars (flow vs time, pressure vs time, volume vs time) and loops (pressure-volume, flow-volume).
2) Scalar graphics show the relationship between flow, volume, or pressure over time. Loops show the relationship between pressure and volume or flow and volume. These graphics provide information about ventilator settings, lung mechanics, and the identification of common issues like airway obstruction or air trapping.
3) Proper analysis of ventilator graphics is essential for optimizing ventilator settings and recognizing abnormalities that may require intervention to improve a patient's ventilation
1) Recruitment maneuvers (RMs) aim to reopen collapsed alveoli in ARDS patients through temporarily increasing transpulmonary pressure. Common types include sighs, sustained inflations, and stepwise increases in pressure.
2) While RMs often improve short-term oxygenation, clinical trials have found no evidence of reduced mortality or improved outcomes. One large trial found RMs may actually increase mortality.
3) Not all ARDS patients respond equally to RMs due to factors like etiology, severity, and lung recruitability. RMs should only be considered for hypoxemic individuals based on an individual risk-benefit assessment.
Non-invasive ventilation (NIV) provides ventilatory support without intubation through a non-invasive interface like a mask. It is used initially to treat type 2 respiratory failure and prevent need for mechanical ventilation. Benefits include avoiding complications of intubation and improving outcomes by reducing mortality, morbidity, ICU/hospital stay, and costs. NIV is appropriate for patients with acute or acute on chronic respiratory failure who are cooperative, hemodynamically stable, and have an adequate cough reflex. Factors determining success include careful patient selection, skilled application and monitoring, and timely transition to invasive ventilation if needed.
This document provides an overview of ventilator basics and parameters including:
1) It describes the basic components and parameters of ventilators such as modes, controls, triggers and adjunct therapies.
2) It explains some common ventilator modes like pressure control ventilation, BiPAP, and APRV and notes some safety considerations.
3) It outlines potential complications from mechanical ventilation and stresses the importance of monitoring patients and equipment.
This document provides information on non-invasive ventilation (NIV) including:
1. The physiologic effects of positive pressure ventilation such as increased laminar flow and alveolar recruitment.
2. Contraindications and types of respiratory failure and their management approaches. BiPAP is used for hypercapnic failure with acidosis while CPAP is used for acute hypoxia.
3. Guidelines for setting pressures on CPAP and BiPAP and troubleshooting persistent hypoxia or hypercapnia by adjusting pressures.
4. Early predictors of NIV failure including a pH <7.3 and lack of acute worsening of chronic respiratory failure.
5. Clinical vignettes describing
The document discusses basic principles of mechanical ventilation including factors that can lead to ventilatory failure, airway resistance, lung compliance, hypoventilation, V/Q mismatch, intrapulmonary shunting, and diffusion defects. It also covers different types of ventilator waveforms including pressure, volume, flow and pressure/volume loops which can be used to assess a patient's respiratory status and response to therapy.
APRV is a ventilation mode that applies CPAP at a high pressure for a prolonged period of time to recruit and maintain lung volume, followed by brief releases to a lower pressure to allow for exhalation and CO2 removal. It aims to preserve spontaneous breathing. APRV is indicated for ARDS management and postoperative atelectasis and has benefits like improved oxygenation and reduced sedation needs but risks include increased work of breathing and worsening of air leaks. Studies comparing APRV to other modes in ARDS patients have found similar outcomes but more research is still needed to determine its full utility.
Noninvasive ventilation (NIV) delivers ventilatory support without an invasive airway. It works by reducing inspiratory muscle work and avoiding fatigue. NIV improves lung compliance and gas exchange while allowing oral intake and speech. The main advantages of NIV are that it is noninvasive and avoids complications of intubation. Potential disadvantages include slower correction of abnormalities and issues with masks like leaks or skin damage. NIV can be administered in emergency departments or wards by trained staff and is used to treat conditions like COPD exacerbations, cardiogenic pulmonary edema, and post-extubation respiratory failure.
The document discusses ventilation and different modes of noninvasive ventilation. It provides details on:
1) How ventilation works through pressure differences that cause air to flow into and out of the lungs. Different factors like resistance and Boyle's law impact this process.
2) The history and development of noninvasive ventilation, from early negative pressure devices to current use of positive pressure ventilation delivered noninvasively through masks.
3) Modes of noninvasive positive pressure ventilation including volume ventilation, pressure ventilation, bilevel PAP, and CPAP. The benefits and limitations of noninvasive ventilation are also summarized.
This document provides an overview of mechanical ventilation including definitions, modes, settings, and management. It discusses non-invasive ventilation techniques like CPAP and BiPAP as well as various modes of invasive ventilation such as CMV, SIMV, and pressure support. Key variables, advantages, and disadvantages of different modes are explained. Graphs are presented to illustrate concepts like PEEP, auto-PEEP, and the relationship between pressure and volume ventilation. Management considerations for various disease states are also covered.
this is compiled & created to discuss the basic modes and initiation of NIV
the author is thankful to the previous authors,teachers who helped to conceptualize the NIV .
This document provides an overview of non-invasive ventilation (NIV), including its definition, historical background, mechanisms of action, indications and contraindications, different modes (CPAP vs BiPAP), and evidence supporting its use. Key points include that NIV avoids intubation and its complications, evidence shows benefits for COPD exacerbations and cardiogenic pulmonary edema, and both CPAP and BiPAP can effectively treat acute cardiogenic pulmonary edema with no differences in patient outcomes.
The document discusses several newer modes of mechanical ventilation including volume assured pressure support (VAPS), volume support (VS), pressure regulated volume control (PRVC), and adaptive support ventilation (ASV). VAPS switches between pressure control and volume control modes within a breath to ensure a minimum tidal volume. VS adjusts pressure support levels between breaths to maintain a target tidal volume. PRVC aims to deliver a set tidal volume with the lowest possible airway pressure by modifying flow and time. ASV automatically adapts support levels to provide a minimum minute ventilation with the least work of breathing.
The document discusses various techniques for invasive and non-invasive neonatal ventilation. It describes conventional mechanical ventilation modes like CMV, IMV, SIMV and newer modes like pressure support ventilation and proportional assist ventilation. It also covers high frequency ventilation, CPAP and newer non-invasive techniques like NIPPV and SNIPPV which aim to provide respiratory support without intubation. The goals, mechanisms, settings and potential complications of different ventilation strategies are outlined.
Mechanical ventilators generate a controlled flow of gas into a patient's airways using various modes of ventilation. There are both positive and negative pressure machines that can be either invasive or non-invasive. Modes include volume cycled, pressure cycled, time cycled, and flow cycled. Ventilators aim to provide oxygenation through settings like FIO2 and PEEP, and ventilation through tidal volume and respiratory rate. They are indicated for conditions causing respiratory failure and can have complications like lung injury, infection, and decreased blood pressure. Settings must be adjusted based on blood gas results and the patient's condition. Weaning involves gradually reducing support as the patient improves. Non-invasive ventilation
Care and basic settings of portable ventilator.pdfmohdzulfahmie
This document discusses mechanical ventilation and ventilator settings. It defines mechanical ventilation as using a mechanical device to assist breathing. The main types are negative pressure ventilation, which applies pressure lower than atmospheric pressure during inspiration, and positive pressure ventilation, which applies higher pressure during inspiration. Modes of ventilation discussed include volume control, pressure control, SIMV, PSV, and CPAP. Key ventilator settings covered are tidal volume, respiratory rate, FiO2, PEEP, I:E ratio, and pressure support. Causes of respiratory failure and appropriate ventilator care are also summarized.
This document discusses non-invasive positive pressure ventilation (NIPPV). It defines NIPPV as ventilation without an invasive airway and notes its increasing use for acute respiratory failure. The document covers the history of NIPPV, indications, goals, advantages, patient selection criteria, initiation procedures, modes (including CPAP, BiPAP, volume vs pressure), and settings. NIPPV can effectively treat various conditions like COPD, heart failure, and respiratory infections while avoiding intubation. Careful patient selection and monitoring are important for successful NIPPV.
This document provides an overview of ventilator basics, including:
1) It describes common ventilator parameters such as tidal volume, flow, and phase variables that control the start and end of breaths.
2) It outlines basic ventilator modes like control, assist-control, SIMV, PCV, PSV, and BiPAP that deliver mandatory or assisted breaths through different control variables.
3) It discusses settings, adjuncts and complications associated with mechanical ventilation to safely manage patients on ventilators.
1) Non-invasive positive pressure ventilation (NIPPV) delivers positive airway pressure without an invasive interface like an endotracheal tube.
2) NIPPV can benefit patients with respiratory failure from COPD, cardiogenic pulmonary edema, obesity hypoventilation syndrome, and other conditions by reducing work of breathing and improving oxygenation.
3) Bi-level positive airway pressure (BPAP) and continuous positive airway pressure (CPAP) are common NIPPV modes. BPAP delivers different pressures during inspiration and expiration while CPAP maintains a constant pressure.
Non-invasive ventilation (NIV) was initially developed to treat polio victims and patients with obstructive sleep apnea. It involves delivering ventilation without intubation by using interfaces like nasal or facial masks connected to ventilators. NIV can be delivered via several modes and is used to treat conditions like COPD exacerbations, cardiogenic pulmonary edema, immunocompromised patients with pneumonia, and as a bridge to weaning from mechanical ventilation or for palliative care. Close monitoring is required as NIV may fail and require intubation. Guidelines provide conditional or strong recommendations for its use in specific acute and chronic clinical situations.
Andreas Vesalius in 1555 suggested opening the trachea and inserting a tube to allow the lung to reinflate and strengthen the heart, representing one of the earliest descriptions of mechanical ventilation.
Dr. Nikhil Yadav's document discusses various modes of mechanical ventilation including controlled modes like volume control and pressure control ventilation, assisted modes like assist-control and synchronized intermittent mandatory ventilation, and spontaneous breathing modes like pressure support ventilation and proportional assist ventilation. The summary provides a high-level overview of the key topics and historical context covered in the document.
The document provides information on various modes of mechanical ventilation and strategies for weaning patients off ventilators. It discusses negative pressure ventilation techniques like iron lungs as well as modern positive pressure modes like pressure control ventilation, synchronized intermittent mandatory ventilation (SIMV), and proportional assist ventilation (PAV). The goals of mechanical ventilation are to maintain ventilation and tissue oxygenation while decreasing the work of breathing. Modes are selected based on the level of support needed and to facilitate eventual weaning from the ventilator.
This document discusses care of children requiring long-term ventilation. It begins with objectives which include discussing incidence, goals, modes of ventilation, guidelines, monitoring, weaning, complications and nursing management. It then covers incidence rates, the difference between pediatric and adult respiratory systems, types of respiratory failure, functions and definitions related to mechanical ventilation. Various modes of ventilation are described along with initial settings, adjustments, weaning priorities and criteria for extubation. Monitoring, complications and troubleshooting are also addressed. Nursing management is a multidisciplinary team approach. Bundles are discussed as a way to ensure delivery of standard care and assess interventions.
Inadequate respiratory drive
Inability to maintain adequate alveolar ventilation
Hypoxia
Decision to provide MV should be based on clinical examination and assessment of gas exchange by blood gas analysis. The principal goal of MV in the setting of respiratory failure is to support gas exchange while underlying diseased process is reversed.
This document discusses various modes of mechanical ventilation including dual control, pressure regulated volume control (PRVC), volume support, pressure control ventilation, airway pressure release ventilation (APRV), and adaptive support ventilation (ASV). PRVC aims to deliver a set tidal volume with minimum inspiratory pressure while allowing breathing above this level. Volume support similarly aims for a target volume but uses the lowest pressure and allows spontaneous breathing. APRV uses higher and lower pressure levels to recruit alveoli and improve gas exchange while allowing spontaneous breathing. ASV is a closed-loop system that automatically adjusts support based on patient breathing patterns and aims.
This document discusses mechanical ventilation and its physiology. It covers the main functions of the lungs related to gas exchange, oxygen diffusion pathways, and factors that determine oxygen diffusion. It then introduces mechanical ventilation, its aims, categories of invasive and non-invasive ventilation, and types of ventilators including conventional and high frequency ventilators. Various ventilation modes, controls, indications, and examples of negative pressure and positive pressure ventilation are also summarized.
Settings Use and Maintenance of Mechanical VentilatorSurendran Radjou
Mechanical ventilation involves using a mechanical device to assist breathing and improve gas exchange. It helps control the airway and breathing workload, replaces exhausted respiratory muscles, and allows use of medications that could otherwise suppress breathing. Key functions include setting oxygen levels, breathing rate and volume, as well as pressures to open collapsed airspaces. Modes include fully controlled, supported, and combined approaches. Weaning gradually reduces ventilator support levels as the patient recovers lung function and the ability to breathe independently.
A 62-year-old female with a history of hypertension, diabetes, and COPD presented with worsening cough, expectoration, and breathlessness over the past 3 days. On examination, she was drowsy with tachycardia, tachypnea, and low oxygen saturation. Tests showed respiratory acidosis and congestive cardiac failure. She was started on non-invasive ventilation (NIV) with initial settings of IPAP 10 cm H2O and EPAP 4 cm H2O, which were gradually increased. NIV was given for decreasing durations over 4 days as her condition improved before being discontinued.
COPD Lecture 10 non invasive and invasive mechanical ventilationDr.Mahmoud Abbas
1) Noninvasive ventilation (NIV) can be used to treat acute respiratory failure from COPD exacerbations, cardiogenic pulmonary edema, and severe asthma. It can reduce the need for intubation compared to standard oxygen therapy alone.
2) When using NIV, careful attention should be paid to the interface and fit to minimize leaks, patient-ventilator asynchrony, and skin breakdown. Appropriate ventilator settings are also important to provide effective ventilation while avoiding overdistention.
3) Nocturnal NIV may provide benefits for stable COPD such as improved gas exchange and sleep, but the evidence is less clear. Patient selection is important, and further research is still needed on its
Care of patient on mechanical ventilator.pptxaneettababu3
Mechanical ventilation provides oxygenation and ventilation for patients who are unable to breathe adequately on their own. It works by delivering positive pressure breaths through an endotracheal tube or tracheostomy. Nurses caring for patients on ventilators must carefully manage the patient's airway, monitor ventilator settings and alarms, prevent complications, and meet the patient's physiological needs. Modes of ventilation include volume control, pressure control, and non-invasive ventilation delivered via face mask. Complications can arise from excessive secretions, equipment issues, or if the patient's breathing is not synchronized with the ventilator.
This document discusses respiratory failure and various modes of mechanical ventilation. It begins by distinguishing between respiratory failure and respiratory insufficiency. It then covers initiating mechanical ventilation using either volume ventilation or pressure ventilation. Various modes are discussed including volume-targeted modes like control, assist, SIMV+PS. Pressure-targeted modes like pressure control ventilation and PSV are also covered. The document discusses the challenges of ventilating ARDS patients and how newer dual modes and closed-loop modes can help minimize ventilator-induced lung injury while maintaining lung recruitment and pressures. It also introduces APRV and bi-level ventilation as newer modes to apply PEEP above the lower inflection point.
basics of mechanical ventilator Dr Asaduzzaman.pptxDr. Habibur Rahim
Mechanical ventilation is an important life-saving intervention for extremely premature and sick newborns. While it supports oxygenation and carbon dioxide removal, it can also cause lung injury if not optimized. The document discusses the physiology of ventilation, components of mechanical ventilators like pressures and volumes, basic ventilation modes, and pulmonary graphics. Modes like volume guarantee aim to balance supporting gas exchange while limiting volumes and pressures. Understanding ventilation principles, ventilator operations, and individualizing strategies are important for achieving optimal outcomes for mechanically ventilated newborns.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Thyroid Gland- Gross Anatomy by Dr. Rabia Inam Gandapore.pptx
Non Invasive Ventilation
1. Non Invasive Ventilation
DR. SOMNATH LONGANI
CONSULTANT ANAESTHESIOLOGIST & INTENSIVIST
MIDLAND HEALTHCARE & RESEARCH CENTRE
LUCKNOW.
2. Learning Objectives
To learn the indication and contraindications of NIV
To learn the various ventilators which can be used for NIV
To understand the modes of NIV
To learn how to apply NIV
To learn the complications of NIV and solutions
3. NIV in Acute Respiratory Failure
(strong Evidence: A)
AECOPD
Weaning in COPD
Cardiogenic Pulmonary edema
Immunocompromised host
4. Indication (Level B)
Acute Respiratory failure in OSA/OHS
Mild ARDS
Postoperative Respiratory Failure
Pre intubation oxygenation
Trauma- Flail chest
6. Assessment of Need of NIV
Moderate to Severe respiratory distress
Tachypnea (RR>25/min)
Accessory muscle use or Abdominal Paradox
ABG pH <7.35, PaCO2 >45mm Hg
PaO2/FiO2<300 or SpO2<92% with FiO2 50%
7. Contraindication
Inability to protect airway
Comatose patient
Patient with Bulbar involvement
Confused and agitated patients
Patients with upper airway obstruction
14. Choice of ventilator
It can easily trigger into respiratory phase in response to patient effort
Preferably flow based
It is easily cycled to expiratory phase
It should have adequate flow to meet patient demand (60-100LPM)
Pressure preset pressure support, pressure control
Capable of providing pressure at least up to 30cm H2O
Should ideally have spontaneous or timed mode
15. Choice of ventilator
Light weight/Portable
Basic alarms
Capable of supporting breath rate of at least 40/min
Adjustable Pressure rise time
Adjustable inspiratory and expiratory triggers
Battery back up
Simple control knobs and ability to prevent inadvertent change of Parameter.
19. IPAP
Increases tidal volume
Improves ventilation
EPAP
Opens up the airway
Improves oxygenation
Neutralizes auto PEEP
Pressure support= IPAP-EPAP
20. Modes of Mechanical ventilation
Pressure-targeted ventilators are the devices of choices for acute NIV
Both Pressure support and Pressure Control modes are effective
Only ventilators designed specifically to deliver NIV should be used
21. Pressure Targeted Ventilation
Pressure delivered is Constant
Pressure targeted ventilation compensates for air leak
Positive pressure throughout expiration
Flushes exhaled CO2 from the mask and distal ventilator tubing
22. Modes of Ventilation in Portable Pressure
ventilators
CPAP
Spontaneous (S)
Spontaneous / Timed (S/T)
Timed (T- Control)
Pressure assist control (PAC)
Intelligent volume assured pressured support (iVAPS)
Proportional Assist ventilation
23. Modes of NIV in ICU ventilators
Pressure support ventilation (PSV)
Pressure control ventilation (PCV)
24. CPAP
Fixed pressure is applied throughout in both inspiration and expiration
Comfortable for patient
Useful for cardiogenic pulmonary oedema
25. Spontaneous Mode (S)
Devices senses the patient breath and triggers IPAP in response to an increase in flow, and cycles
into EPAP at the end of respiration.
Breath rate and respiratory pattern will be decided by patient.
If the patient fails to make adequate inspiratory efforts, no ventilator support is delivered.
27. Spontaneous/ timed mode
In the S/T mode (Assist control) mode, a back up rate is set by the operator
If the patient’s RR is slower than the back up rate , machine determined breath will be delivered
If the patient breath faster than the back up rate, no machine determined breath will be
delivered and all breath will be triggered ( or assisted)
The proportion of controlled and assisted breaths often varies, depending on the patients state
of alertness and respiratory drive.
29. Timed mode (T)
Also known as control mode
Fixed breath rate and the fixed inspiratory time set by the clinician are supplied regardless of
patient efforts.
31. Pressure Assist Control (PAC)
Inspiration time is set
No spontaneous or flow cycling
Inspiration can be triggered by patient when respiratory rate is above a preset value.
Ti will be fixed in all breath cycle
33. Intelligent Volume Assured Pressure Support
(i-VAPS)
Indicated for patient of 30kg and above
Designed to maintain a preset target alveolar ventilation, adjusting the pressure support and
providing an intelligent back up breath automatically.
Auto EPAP automatically adjust the EPAP to maintain upper airway patency.
36. Proportional Assist Ventilation (PAV)
The ventilator assists the patient by generating volume and pressure in proportion to patient’s
effort creating a ventilator pattern that matches metabolic demands on a breath-by-breath
basis.
Till date,there is no data to show any advantage of PAV.
38. Technique to minimise CO2 rebreathing
Increase EPAP level
Increase leak in system
Fixed leak in the mask rather than hose
Titrate O2 into mask rather than hose
Plateau exhalation valve
39. Interfaces
Interfaces are devices that connect the ventilator tubing to the patient and facilitate the entry of
pressurized gas into the upper airways during NIV.
Full face masks (oro-nasal masks)
Total face masks
Nasal face masks
Nasal Pillow
Mouthpieces
40. Choice Of Interface for NIV
A Oro-nasal mask or full face mask should usually be the first type of interface used acutely
dyspnoeic patient
A range of masks and sizes should be available
NIV circuits must allow adequate clearance of exhaled air through an exhalation valve or an
integral exhalation port on the mask.
42. It permits mouth breathing and reduces air leaks through the mouth
May be preferred by acutely dyspneic patient who are mouth breathers
Interfere more with speech, eating and expectorations and may contribute more dead space
than nasal masks.
45. Nasal Masks
Advantages Disadvantages
Less risk of aspiration Mouth leak
Enhance secretion clearance Less effectiveness with nasal obstruction
Less claustrophobia Nasal irritation and rhinorhea
Easier speech Mouth dryness
Less dead space
51. Choose the correct interface.
Explain therapy and its benefit to the patient in detail. Also discuss the possibility of intubation.
Set the NIV portable pressure ventilator in spontaneous or spontaneous /timed mode.
Start with very low settings. Start with low inspiratory positive airway pressure (IPAP) of 6 – 8
cm H20 with 2 to 4 cm H20 of EPAP (Expiratory positive airway pressure). The difference
between IPAP and EPAP should be at least 4 cm H20.
Administer oxygen at 2 liters per minute.
Hold the mask with the hand over his face. Do not fix it.
52. Increase EPAP by 1-2 cm increments till all his inspiratory efforts are able to triggers the
ventilator.
If the patient is making inspiratory effort and the ventilator does not respond to that
inspiratory effort, it indicates that the patient has not generated enough respiratory effort to
counter auto PEEP and trigger the ventilator (in COPD patients).
Increase EPAP further till this happens. Most of the patients require EPAP of about 4 to 6
cmH2O.
Patient who are obese or have obstructive sleep apnea require higher EPAP.
53. Now start increasing IPAP in increments of 1-2 cm up to a maximum pressure, which the
patient can tolerate without discomfort and there is no major mouth or air leaks.
In some NIV machine, inspiratory time(Ti) can be adjusted. Setting the Ti at one second is a
reasonable approach.
Now secure interface with head straps. Avoid excessive tightness. If the patient has a
nasogastric tube put a seal connector in the dome of the mask to minimize air leakage.
After titrating the pressure, increase oxygen to bring oxygen saturation to around 90%.
As the settings may be different in wakefulness and sleep, readjust them accordingly.
When all the patient’s efforts are triggering the ventilator, leave EPAP at that level.
54. Titration- Set respiratory rate and
inspiratory time
Set Back up Rate 2-3 breaths below patient spontaneous breathing
Obstructive Patients Ti from 25-33%
Restrictive Patients Ti from 33-50%
Ti (Second)= (60/RR) x %Ti
55. The tolerance and acceptance of the
patient to the mask and pressure setting
The degree of upper airway obstruction or intrinsic PEEP pressure
Respiratory drive during wakefulness and sleep
Ability of the patient to trigger the device
IPAP-EPAP difference, ie. Pressure support
Airflow resistance
Compliance of the respiratory system
Inspiratory time
56. Alarm setting
Adjust high and low tidal volume
Alarm 10% above and below average value for tidal volume
Adjust high and low pressure alarms (5cm above and below the peak airway pressure)
58. Application of NIV using ICU ventilators
First step is to select the right ventilator and mask
Explain the therapy to the patient
Choose an appropriate interface
Put in NIV mode
Keep FiO2 -50%
Start with lower setting of PS 8-10 and PEEP of 4-5cm H2O
59. Initiate NIV while holding the mask in place and confirm optimum fit. Change if it is too big or
small
Hold the mask and don’t fix the headgear
Once the patients inspiratory efforts trigger the ventilator, start increasing pressure support
further keeping the patient comfort in mind
Increase FiO2 to maintain target oxygen SpO2
Secure interface with the headgear
It should be tight but not over tight
Small leaks are acceptable
60. Humidification in NIV
No evidence to guide the use of humidification in Acute NIV
Humidification is not routinely required
Heated humidification may be useful where mucosal dryness and respiratory secretions are
thick and tenacious.
It may reduce upper airway resistance and increase comfort when leak is high
61. Humidification devices includes
i. Heated or unheated pass over devices
ii. Pass through devices
iii. Heat and moisture exchangers
With pressure targeted ventilators only pass-over humidifiers should be applied, since pass
through devices and Heat and moisture exchangers may compromise pressure and flow delivery
and triggering.
62.
63. Bronchodilator therapy in NIV
Nebulised drugs-during breaks from NIV
If the patient is dependent on NIV, bronchodilator drugs can be given via a nebuliser inserted
into the ventilator tubings
65. Monitoring Of NIV
Mask comfort
Tolerance of ventilator setting
Respiratory distress
Respiratory rate
HR, SpO2, pH, pCO2
Sensorium
Accessory muscle use
Abdominal paradox
66. Monitoring Of NIV
Ventilator parameter
Air leaking
Adequacy of pressure support
Adequacy of PEEP
Tidal volume (6-8ml/kg)
Patient-ventilator synchrony
67. To control pH and pCO2 manipulate the RR, Tidal volume and Minute ventilation
To control pO2 adjust the FiO2 and the mean airway pressure( PEEP and PIP)
68. Discontinuation of NIV
NIV failure:
Worsening mental status
Detioration in pH and pCO2 after 1-3hours of NIV
Refractory hypoxemia: even a brief discontinuation of NIV leads to significant fall in SpO2
Intolerance to NIV
Hemodynamic instability
Inability to clear secretions
71. Air leaks
Air leak in NIV
Increase flow to maintain pressure of IPAP
Inspiration is prolonged into patient expiratory efforts
Dysynchrony or Non triggering
72. NIV complications
Complications Corrective actions
Mask discomfort
Excessive leaks
Check mask for correct size and fitting
Minimize headgear tension
Pressure sores Use forehead spacers or change to a different masks
Apply Duoderm, wound care dressings
Nasal or oral dryness or nasal congestion Add or increase humidification
Irrigate nasal passage with saline
Apply topical decongestants
Aerophagia/gastric distension Use lowest effective pressure for adequate tidal volume
Use simethicone agents
Aspirations Make sure patient are able to protect airways
Mucus Plugging Ensure adequate hydration
Ensure adequate humidifications
Avoid excessive O2 flow rates (>20L/min)
Allow short breaks from NIV to directed coughing technique.
Hypotension Avoid excessively high airway pressure
Barotrauma Use PCV, Low PIP, Avoid desynchrony
73. Conclusions: Making NIV successful
Select right patient, Interface and Ventilator
Rule out contraindications
Monitor closely for comfort, air leak and desynchrony
Dedicated and trained staff
74. Take Home Message
NIV is Healing when used judiciously and Hurting when used non selectively and
inappropriately.