Week 2 - Ventilatory support and NIV

Question 1

Discuss physiotherapy for hypercapnic patients.

4 points

Answer 1

Reduce the load by:

• reduce obstruction/airway resistance
• increase compliance (reverse atelectasis where poss.)
• Reduce uneccessary activity/load

-Improve length/tension of diaphragm

Question 2

Discuss physiotherapy for hypoxaemic patients.

3 points

Answer 2

• increase SA (PEEP, CPAP) to increase FRC
• increase O2 movement by increasing breath size and clearing secretions
• Minimise expenditure with positioning

Question 3

What are the clinical reasons for NIV?

5 points

Answer 3

• Respiratory acidosis, high CO2
• High WOB (accessories, high RR)
• Clincal impression of deterioration
• Moderate to severe dyspnoea
• Not responding to standard care

Question 4

What criteria must a person meet before NIV can be considered an option?

5 points

Answer 4

Haemodynamically stable
Single system failure - respiratory
Doesn't need immediate intubation
Co-operative, non-combative
Manageable secretions

Question 5

What are some contraindications to NIV?

8 points +

Answer 5

Refractory (non-responding) hypoxemia
Low GCS scale
Reflexes not intact
Facial/mouth/oral trauma, surgery or burns
Sepsis
Undrained pneumothorax
Vomiting, bowel obstruction
Uncooperative

Question 6

What are some conditions that NIV is good for?

Answer 6

COPD
Acute on chronic hypercapnia e.g.
obesity related
NM e.g. polio
Chest wall deformity

Question 7

Role of the physio in NIV.

Answer 7

Help with secretion clearance

Early mobilisation