Non invasive ventilation

Question 1

Discuss indications for NIV

Answer 1

WOB
Hypercapnia
Acidosis
hypoxia despite high fio2

Question 2

Discuss contra-indications to NIV

Answer 2

• -Agitation
• -hypersecretion
• -coma
• -severe acidosis <7.1
• -inability to protect airway
• HD instability
• pneumothora
• apnoea

Question 3

Discuss complications that can be associated with NIV

Answer 3

Claustraphobia
gastric distension until patient learns to co-ordinate breathing and laryngeal movements
aspiration
dryness of nose/rhinorrhoea

Question 4

Discuss setting

Answer 4

reasonable to start at 8-10cmh20 IPAP
4-6cmh20 EPAP
fi02 1

Once patient tolerating able to change pressures as needed
Changing IPAP or EPAP depends on whether ventilation or oxygenation is the primary problem

If persistent acidosis check
-circuit leak, wrong size mask 
-expiratory valve wongly fitted 
- is the patient rebreathing 
-failure to synch with ventilator 
If non of the above increase IPAP by increments of 2

If persistant hypoxia increase fio2 to 1 or increase EPAP