Non invasive ventilation

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