Non-invasive ventilation (NIV) delivers mechanical ventilation without an artificial airway by using techniques like CPAP and BiPAP. NIV improves alveolar ventilation, reduces work of breathing, and avoids complications of endotracheal tubes. It is useful for conditions like respiratory failure, atelectasis, and cardiogenic pulmonary edema. While NIV has advantages of being non-invasive and improving patient comfort, it also has disadvantages like slower correction of abnormalities and potential for skin irritation or air leakage. Different modes like CPAP and BiPAP are used depending on if the patient has hypoxemia or hypercapnia. NIV requires supervision and is contraindicated in patients with impaired consciousness or inability to protect their

1. NON INVASIVE VENTILATION

2. DEFINATION
• Noninvasive ventilation refers to the delivery of mechanical
ventilation to the lungs using techniques that do not require invasive
artificial airway(endotracheal tube, tracheostomy)
• EFFECTS OF NIV:
• Improves alveolar ventilation to reverse respiratory acidosis and
hypercarbia
• Recruits alveoli and increases FRC to reverse hypoxia
• Reduces work of breathing

3. ADVANTAGES
• Application –easy to implement or remove
• Improves patient discomfort
• Reduces the need for sedation
• Oral patency( preserves speech, swallowing,cough)
• Avoids resistive work of ETT
• Avoids complications of ETT like local trauma, aspiration
• Reduced cost and length of stay

4. DISADVANTAGES
• Slower correction of gas exchange abnormalities
• Mask-facial skin necrosis, air leakage, eye irritation
• Lack of airway access and protection
• Compliance/claustrophobia
• Requires supervision

5. MODES
• Hypoxemia = CPAP
• Hypercapnia and hypoxia =BiPAP

6. CPAP(CONTINOUS POSITIVE AIRWAY PRESSURE)
• provides constant positive airway pressure throughout cycle
• improves oxygenation
• decreases work of breathing by alveolar recriutment
• decreases hypoxia by alveolar recruitment and reduces
intrapulmonary shunt

7. INDICATIONS
• when patient is hypoxic despite medical intervention
• atelactasis-complete or partial collapse of lung
• rib fractures- to stabilise fractures and prevent damage to the lung
• type 1 respiratory failure
• congestive cardiac failure
• cardiogenic pulmonary odema

8. BIPAP
• bilevel pressure support
• combination of IPAP and EPEP
• A bilevel pressure respond and support patient spontaneous
inhalation(IPAP) and exhalation(EPAP)
• once patient do not start inhaling within a set time,device
automatically start inhalation
• After inhalation device automatically decreases the pressure (EPAP)
for patient exhalation
• ventilation is provided mainly by iPAP whereas ePAP recriuts
underventilated or collapsed alveoli for gas exchange and allows
removal of exhaled gas

9. INDICATIONS
• type 2 respiratory failure
• acute exacerbation of COPD
• increased work of breathing like in neuromuscular disorder
• weaning from tracheal intubation

10. CONTRAINDICATIONS
• impaired consciousness, confusion
• inability to protect airway
• excessive secretion or vomiting
• haemodynamic stability
• untreated pneumothorax
• bowel obstruction
• facial trauma, burns , surgery

11. COMPLICATIONS
• Hypoxia
• reduced cardiac output
• vomiting and aspiration
• pressure areas
• gastric distention