3. DEFINITION OF NIV :
• It is a form of Mechanical Ventilation that
provides respiratory assistance without an
invasive artificial airway or endotracheal
airway . NIV may prevent the use or need of
endotracheal intubation .
4. TYPES OF NIV :
1. BIPAP (Bi-level positive air way pressure)
2. CPAP (Continuous positive air way pressure)
3. PSV (Pressure support ventilation)
5. INDICATIONS NIV
1. Bedside observation
Moderate to severe dyspnea or respiratory distress
Tachypnea > 25 bpm for 30 Minutes
Accessory muscle use or abdominal paradox
2. Gas exchange or ABGs
Acute or acute on chronic respiratory failure
paco_2 > 50 mmHg
pao_2/ Fio_2 = 200
ph<7.35 and > 7.25
6. RESPIRATORY CONDITIONS
LIKELY TO RESPOND TO NIV
• Hypoxemic respiratory failure ( pao2 < 60 mm
• Cardiogenic pulmonary edema without
hemodynamic instability
• Respiratory failure in patient with pneumocystis or
pneumonia
• Patient who are not candidate for intubation
• Respiratory failure in Immunicompromised patient
7. HYPERCAPNIC RESPIRATORY
FAILURE ( PCO2>50 MMHG)
• Acute exacerbation of COPD
• Acute exacerbation of asthma
• Respiratory failure in patients with cystic fibrosis
• Patient who are not candidate for intubation or DNR
8. OTHERS :
• Preparing of weaning from invasive ventilation
• Chronic neuromuscular disorder like motor neuron
diseases
9. CONTRAINDICATIONS OF NIV
• Significant agitation
• Cardiac or respiratory arrest
• Myocardial ischemia or arrhythmias
• Hemodynamic instability
• Patient with upper GI Bleed
• Inability to protect the airway
• Low GCS < 9
10. CONTRAINDICATIONS OF NIV
• Excessive secretions
• Ineffective cough
• Distended abdomen
• Persistent vomiting
• Facial trauma
• Esophageal surgery
• Severe encephalopathy
11. INITIATION OF NIV
• Don’t delay intubation if needed
• Arterial blood gases analysis should be considered
prior to initiation
• Explain the procedure to patient
• Keep head if bed at >, 45
• Ensure appropriate mask
• Assess the patient tolerance of the mask by applying
it by hand before securing the horness
13. USE THE FOLLOWING INITIAL
VENTILATION SETTING FOR BIPAP
A. Mode : spontaneous
B. Fio_2 100 %
C. EPAP 5cm H20 initially
D. IPAP 10 – 15 cm H20
E. Backup rate 6|mit
Pressure less than 8 / 4cm H20 not advised as this may be
not adequate
Initial adjustment to achieve tidal volume of 5-7mllkg
14. SETTING FOR CPAP WITH PRESSURE SUPPORT
1. Initial pressure support starts from 10 cm H20
2. Initial peep of 6cm of H20
15. MONITORING OF NIV
1. Increase the IPAP or pressure support if 2-5cm
Every 10 minutes or an clinically indicated until target
tidal volume has reached (5-8 m/kg)
2. The maximum IPAP or pressure support should not
exceed 20-25 cm if H20
16. 3. Titrate fio2 that achieve spo2 more than 90 % and
02 more than 60 mmgh
4. If the patient does not improve in one hour of
starting NIV , then consider intubation
