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Non Invasive Ventilation Update

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Dr.Mahmoud Abbas
Dr.Mahmoud Abbas

Presentation of Dr. Dean Hess at 10th Pulmonary Medicine Update Course, Cairo, Egypt. Pulmonary Medicine Update Course is organized by Scribe : www.scribeofegypt.com

Saúde e medicina
1 de 36
Dean R. Hess PhD RRT Associate Professor of Anesthesia Harvard Medical School Assistant Director of Respiratory Care Massachusetts General Hospital Editor in Chief Respiratory Care Noninvasive Ventilation: Update 2010
NIV versus CPAP CPAP = EPAP = PEEP No ventilation assistance with CPAP
Mask CPAP ,[object Object],[object Object],[object Object],[object Object]
Evidence for NIV COPD Exacerbations ★★★★★ Acute cardiogenic pulmonary edema ★★★★ Prevent extubation failure ★★★ Transplantation, immunocompromise ★★ Respiratory failure following lung resection ★ Acute hypoxemic respiratory failure ? Asthma ? Do not intubate/Do not Resuscitate ★ /− Failed extubation −
COPD Exacerbation ,[object Object],[object Object],[object Object],Picot, Cochrane Database of Systematic Reviews 2008
Cardiogenic Pulmonary Edema ,[object Object],[object Object],[object Object],[object Object],Vital, Cochrane Database of Systematic Reviews 2008
Post-Extubation NIV ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Copyright ©2009 BMJ Publishing Group Ltd. Burns et al. BMJ 2009;338:b1574 Effect of non-invasive and invasive weaning on mortality in critically ill adults
Hypoxemic Respiratory Failure ,[object Object],[object Object],Ferrer, Am J Respir Crit Care Med 2003; 168:1438 The literature does not support the routine use of NIV in all patients with acute hypoxemic respiratory failure. Keenan, Crit Care Med 2004; 32:2516
NIV for Acute Asthma ,[object Object],[object Object],Soroksky, Chest 2003; 123:1018
[object Object],[object Object],[object Object],N Engl J Med 2001;344:481
Crit Care Med 2005;33:1976
Copyright ©2009 BMJ Publishing Group Ltd. Burns et al. BMJ 2009;338:b1574 Effect of alternative weaning strategies on VAP in critically ill adults
Nosocomial Pneumonia NIV compared with invasive mechanical ventilation patients assigned to NIV or invasive mechanical ventilation patients assigned to NIV or standard therapy Hess, Respir Care 2005;50:924
Patient Selection for NIV ,[object Object],[object Object],[object Object],[object Object],Step 1: Patient needs mechanical ventilation
Exclusions for NIV ,[object Object],[object Object],[object Object],[object Object],Step 2: No exclusions for NIV
When to Stop ,[object Object],[object Object],[object Object],[object Object],When to Transfer to ICU ,[object Object],[object Object],[object Object]
Is NIV Appropriate? Is NIV NOT Appropriate? When To Stop?
The Interface ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
nasal total face oronasal pillows mouthpiece helmet
Choice of Interface ,[object Object],[object Object],[object Object],[object Object],[object Object]
Mouth Leak ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Oronasal mask; coaching?; chin strap?
Skin Breakdown ,[object Object],[object Object],[object Object],[object Object],photo courtesy Dr. Nick Hill
Ventilators for NIV
Ventilators for NIV ,[object Object],Trigger Pressure vs volume (PCV vs PSV vs PAV) Rise time Cycle Back-up rate
AVAPS: Average Volume Assured Pressure Support ,[object Object],[object Object],[object Object]
blower & pressure controller single hose leak ,[object Object],[object Object],[object Object],[object Object],[object Object],mask
Inhaled Bronchodilators ,[object Object],[object Object],Hess, J Aerosol Med 2007; 20:S85 Iosson, N Engl J Med 2006; 354:e8
 
Managing Dys-Synchrony ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Practical Application ,[object Object],[object Object],[object Object],[object Object]
Practical Application ,[object Object],[object Object],[object Object],[object Object]
Practical Application ,[object Object],[object Object],[object Object],[object Object]
Complications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],(Complications are usually minor)
Cough Assist
NIV Success clinician skills equipment selection patient selection

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Non Invasive Ventilation Update

  • 1. Dean R. Hess PhD RRT Associate Professor of Anesthesia Harvard Medical School Assistant Director of Respiratory Care Massachusetts General Hospital Editor in Chief Respiratory Care Noninvasive Ventilation: Update 2010
  • 2. NIV versus CPAP CPAP = EPAP = PEEP No ventilation assistance with CPAP
  • 3.
  • 4. Evidence for NIV COPD Exacerbations ★★★★★ Acute cardiogenic pulmonary edema ★★★★ Prevent extubation failure ★★★ Transplantation, immunocompromise ★★ Respiratory failure following lung resection ★ Acute hypoxemic respiratory failure ? Asthma ? Do not intubate/Do not Resuscitate ★ /− Failed extubation −
  • 5.
  • 6.
  • 7.
  • 8. Copyright ©2009 BMJ Publishing Group Ltd. Burns et al. BMJ 2009;338:b1574 Effect of non-invasive and invasive weaning on mortality in critically ill adults
  • 9.
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  • 12. Crit Care Med 2005;33:1976
  • 13. Copyright ©2009 BMJ Publishing Group Ltd. Burns et al. BMJ 2009;338:b1574 Effect of alternative weaning strategies on VAP in critically ill adults
  • 14. Nosocomial Pneumonia NIV compared with invasive mechanical ventilation patients assigned to NIV or invasive mechanical ventilation patients assigned to NIV or standard therapy Hess, Respir Care 2005;50:924
  • 15.
  • 16.
  • 17.
  • 18. Is NIV Appropriate? Is NIV NOT Appropriate? When To Stop?
  • 19.
  • 20. nasal total face oronasal pillows mouthpiece helmet
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  • 36. NIV Success clinician skills equipment selection patient selection

Notas do Editor

  1. Hess, Mechanical Ventilation
  2. Hess, Mechanical Ventilation