NIV

Question 1

What are the two categories of NIV ?

Answer 1

Acute care setting
chronic care setting

Question 2

What are some of the benefits of NIV

Answer 2

-reduces need for intubation
- reduces nosocomial infection (UTI patient is more independent) (reduces VAP)
- Reduces need for sedation
- improves mobilization (pt is able to take care of their own bronchial hygiene )
- pt is able to communicate

Question 3

When is NIV Useful ?

Answer 3

• increase WOB
• poor oxygenation
• inadequate ventilation
  (but not to the point where they are impending resp failure or have an acute medical instability such as severe MI, intracranial bleed)

Question 4

List some of the indications for NIV

Answer 4

• Elevated WOB
• Recruitment of accessory muscles
• Tachypnea, RR staying above 25 for extended periods
  -Dyspnea
  -Respiratory acidosis
• Acute or unresponsive Hypoxemia

Question 5

List some of the contraindication of NIV

Answer 5

• Pt is combative, low LOC and has high anxiety (all signs of impending ventilatory failure)
• Low LOC ( Somnolence)
  inability to protect the airway and high aspiration risk
  risk of apnea or loss of drive to breath
• significant cardiac instability ( Uncontrolled severe dysthymias and/ or evidence of significant MI.
  unresponsive low BP
  Upper airway obstruction or lesion
  unable to fit mask (facial trauma, burns or surgery, beards, abnormal structure)
  Copious secretion

Question 6

Pt population that can benefit from NIV

Answer 6

• COPD
• Asthma
• CHF (cardiogenic pulmonary edema)
  -Restrictive lung disorders
• neuromuscular disease
• Pneumonia
  -OSA (obesity hypoventilation)
• Atelectasis
• Weaning from ventilation (treating failure post extubation, improving success)
• end of life care of “do not intubate patient” as a prolongation of life

Question 7

What device best measures NIV flows ?

Answer 7

Standard ICU ventilator will use a dual limb circuit
inspiratory and expiratory limbs
volumes and flow are more accurately measured
Circuit flow is adjusted to compensate for leaks
(different mask use, the one with no holes)

Question 8

What is a single limb circuit

Answer 8

Flow only goes to the patient, no return flow
Expiration is through a side port on circuit and mask holes
measured values are less accurate
can compensate for leaks as long as they are nor excessive