Noninvasive Ventilation (NIV): An Overview (2024)

Noninvasive ventilation (NIV) is a critical technique in respiratory care that delivers ventilatory assistance without the need for invasive procedures like endotracheal intubation.

This method is widely used in clinical settings to manage patients with acute and chronic respiratory failure, offering numerous advantages such as reduced risk of infection, improved patient comfort, and shorter hospital stays.

This article provides a comprehensive overview of noninvasive ventilation, including the goals, types, indications, and potential hazards.

 

What is Noninvasive Ventilation (NIV)?

Noninvasive ventilation (NIV) is a method of providing ventilatory support to patients who are experiencing respiratory distress but are not in immediate need of intubation, where a tube is inserted into the airway. NIV is called “noninvasive” because it doesn’t require surgical insertion of equipment into the body, unlike invasive mechanical ventilation.

Goals

The goals of noninvasive ventilation (NIV) include:

• To improve oxygenation
• To improve ventilation
• To reverse hypoxemia
• To reverse acute respiratory failure
• To provide relief for respiratory distress
• To reverse respiratory muscle fatigue
• To improve pulmonary mechanics
• To prevent or reverse atelectasis
• To improve lung compliance

Note: The strategic use of NIV plays a crucial role in enhancing respiratory care and improving patient outcomes across various clinical settings.

Indications

Noninvasive ventilation (NIV) is indicated for a variety of respiratory conditions and situations. Key indications include:

• Severe hypoxemia
• Severe asthma
• COPD exacerbation
• Acute heart failure
• Post-extubation support
• Moderate acidemia
• Moderate hypercarbia
• Nocturnal hypoventilation
• Obesity hypoventilation syndrome
• Sleep apnea

Note: NIV is a versatile and effective tool in managing a wide range of respiratory conditions, providing significant benefits in terms of patient outcomes and quality of life.

Contraindications

Noninvasive ventilation (NIV) is not suitable for all patients and conditions. Key contraindications include:

• Lack of cooperation
• Cardiac arrest
• Respiratory arrest
• Excessive secretions
• Inability to fit in a mask
• Inability to protect the airway
• Severe facial burns or trauma

Note: Recognizing these contraindications is essential for ensuring the safe and effective use of NIV in clinical practice.

Complications

Noninvasive ventilation (NIV) can be highly effective but not without potential complications, such as:

• Aerophagia
• Airway dryness
• Aspiration
• Claustrophobia
• Decreased cardiac output
• Dry mouth
• Secretion build-up inside the mask
• Eye irritation from an air leak
• Pressure sores from mask, tubing, and straps

Note: Awareness and management of these potential complications are crucial for the safe and effective use of noninvasive ventilation.

Types of Noninvasive Ventilation

Noninvasive ventilation (NIV) encompasses various modes and methods to support patients with respiratory failure.

The primary types include:

1. Continuous positive airway pressure (CPAP)
2. Bilevel positive airway pressure (BiPAP)

CPAP

Continuous positive airway pressure (CPAP) is a type of noninvasive ventilatory support that maintains a constant pressure above atmospheric levels throughout the entire breathing cycle.

This continuous pressure helps to keep the airways open, thereby preventing collapse and facilitating easier breathing.

Since CPAP does not deliver mandatory breaths, it requires the patient to be breathing spontaneously to benefit from the pressure support.

CPAP is frequently used for patients with sleep apnea, as it effectively prevents apneic episodes by maintaining airway patency.

BiPAP

Bilevel positive airway pressure (BiPAP) is a form of noninvasive ventilation that provides two distinct levels of pressure support:

1. Inspiratory Positive Airway Pressure (IPAP): Applied during the inhalation phase, IPAP supports the breathing effort and increases the tidal volume delivered to the patient. It functions similarly to the peak airway pressure in traditional mechanical ventilation. Adjusting the IPAP setting directly affects the volume of air the patient inhales with each breath.
2. Expiratory Positive Airway Pressure (EPAP): Applied during the exhalation phase, EPAP helps keep the airways open and improves oxygenation. It operates similarly to positive end-expiratory pressure (PEEP) in traditional mechanical ventilation. Increasing the EPAP setting enhances the patient’s oxygenation by maintaining positive pressure at the end of expiration.

The primary goal of BiPAP is to alleviate acute respiratory failure without the need for an artificial airway.

This dual-pressure system is particularly beneficial for patients with conditions such as COPD, congestive heart failure, and other respiratory disorders that require different levels of support during inhalation and exhalation.

BiPAP vs. CPAP

BiPAP and CPAP are both types of noninvasive ventilation, but they differ in key ways:

• Pressure Levels: BiPAP delivers two levels of pressure—Inspiratory Positive Airway Pressure (IPAP) and Expiratory Positive Airway Pressure (EPAP)—while CPAP delivers a single continuous level of pressure throughout the breathing cycle.
• Adjustability: In BiPAP, the IPAP and EPAP settings can be adjusted independently to optimize both ventilation and oxygenation. CPAP, on the other hand, maintains one constant pressure level aimed primarily at improving oxygenation.
• Ventilation vs. Oxygenation: BiPAP enhances both ventilation (by supporting the patient’s inspiratory effort) and oxygenation. CPAP is primarily focused on improving oxygenation by keeping the airways open.
• Common Uses: BiPAP is often used for patients with conditions like COPD or heart failure, where both ventilation and oxygenation support are needed. CPAP is most commonly used for patients with obstructive sleep apnea to prevent airway collapse during sleep.
• Spontaneous Breathing Requirement: Both types can be integrated into conventional mechanical ventilation strategies. However, it’s crucial to note that patients must be capable of spontaneous breathing for CPAP to be effective.

Note: Both BiPAP and CPAP offer unique benefits and are integral in managing various respiratory conditions, each catering to different patient needs based on their specific respiratory requirements.

Interfaces for Noninvasive Ventilation

Interfaces for noninvasive ventilation (NIV) are masks or devices that connect the patient to the ventilator, ensuring effective delivery of support.

There are four primary types of interfaces, each with unique benefits tailored to patient needs and preferences:

• Nasal Mask: Covers the nose only and is commonly used with CPAP for sleep apnea patients. It is generally well-tolerated but may cause issues like air leakage in mouth-breathers and nasal dryness or drainage.
• Oronasal Mask: Covers both the nose and mouth, offering a better seal and reducing air leakage. It is suitable for patients who breathe through their mouth but poses risks such as aspiration and regurgitation. Modern oronasal masks typically include safety valves to prevent asphyxiation in case of machine or power failure.
• Nasal Pillows: Consist of small prongs that fit into the nostrils, making them the smallest and often the most comfortable interface. However, they can cause nasal congestion, dry mouth, and nosebleeds, and are prone to air leakage through the mouth. Nasal pillows are frequently used in CPAP therapy but are not recommended for BiPAP.
• Full-Face Mask: Encloses the entire face and is typically used for patients who breathe significantly through their mouth, such as those experiencing acute exacerbations of COPD. While it provides comprehensive coverage, it is often uncomfortable for many patients due to its size.

Note: Selecting the appropriate interface depends on the patient’s breathing pattern, comfort preferences, and specific clinical needs, ensuring effective and patient-centered noninvasive ventilation.

Noninvasive Ventilation Practice Questions

1. What is CPAP?
CPAP stands for Continuous Positive Airway Pressure. It is a constant pressure applied to a spontaneously breathing patient to help keep the airways open.

2. CPAP is applied via what?
CPAP is applied via a mask-type device that covers the nose or both the nose and mouth.

3. CPAP does not do what?
CPAP does not provide volume change or assist in the patient’s minute ventilation.

4. What are some indications for CPAP?
CPAP is indicated for the treatment of obstructive sleep apnea and can also be used to improve oxygenation in patients with certain respiratory conditions.

5. What does NPPV stand for, and what does it do?
NPPV stands for Noninvasive Positive Pressure Ventilation. It provides pressure intermittently, with a higher pressure during inspiration than expiration, to support breathing without the need for intubation.

6. What are the indications for NPPV?
NPPV is indicated for acute respiratory failure and chronic respiratory failure in certain patients.

7. What does NPPV provide?
NPPV provides greater flexibility in the initiation and removal of mechanical ventilation, allowing for noninvasive support.

8. What does NPPV permit?
NPPV permits normal eating, drinking, and communication with the patient, maintaining a more natural lifestyle.

9. What does NPPV preserve?
NPPV preserves airway defense, speech, and swallowing mechanisms.

10. NPPV avoids trauma associated with what?
NPPV avoids trauma associated with intubation and the complications of artificial airways.

11. What does NPPV reduce the risk of?
NPPV reduces the risk of ventilator-associated pneumonia (VAP).

12. NPPV also reduces the risk of what?
NPPV reduces the risk of ventilator-induced lung injuries associated with high ventilating pressures.

13. NPPV reduces muscle work and helps to what?
NPPV reduces muscle work and helps to avoid respiratory muscle fatigue that may lead to acute respiratory failure.

14. Does NPPV provide ventilator assistance with greater comfort, convenience, and less cost than invasive ventilation?
Yes, NPPV provides ventilator assistance with greater comfort, convenience, and at a lower cost than invasive ventilation.

15. NPPV reduces the requirements of what?
NPPV reduces the requirements for heavy sedation.

16. NPPV reduces the need for what?
NPPV reduces the need for invasive monitoring.

17. What does NIV stand for?
NIV stands for Noninvasive Ventilation.

18. What are some contraindications of NIV?
Contraindications for NIV include respiratory arrest (apnea) or the need for immediate intubation, inability to protect the airway, excessive secretions, hemodynamic instability, agitated or confused patients, paradoxical breathing, and upper airway obstruction.

19. What are some other contraindications of NIV?
Other contraindications for NIV include facial deformities or conditions that could prevent a good mask fit, untreated pneumothorax, uncooperative or unmotivated patients, brain injury with unstable respiratory drive, major organ damage (severe hemorrhaging), recent gastrointestinal surgery, and irreversibility of the disorder.

20. What are devices that can be used to provide NIV?
Devices for NIV include nasal masks, full-face masks, nasal pillows, nasal cushions, and total face masks.

21. When fitting the nasal mask, what should you choose?
Choose the smallest mask that does not obstruct the nostrils.

22. Where are some anatomic leak points with the nasal mask?
Leaks can occur at the sides of the nose, the bridge, and above the lip.

23. For the nasal mask, the top of the mask is placed just above what?
The top of the mask should be placed just above the junction of the nasal bone and cartilage.

24. The nasal mask should not be pinching the nose where?
The nasal mask should not pinch the nose at the sides.

25. The lower part of the nasal mask should fit just above what?
The lower part of the nasal mask should fit just above the upper lip.

26. What is a common error in fitting the nasal mask?
A common error is choosing a mask that is too large.

27. What is the best option for a patient in respiratory failure who continues to deteriorate 30 minutes after the initiation of NIV?
Intubate and initiate mechanical ventilation

28. What are some advantages of nasal masks?
Advantages of nasal masks include less risk of aspiration, enhanced secretion clearance, less claustrophobia, easier speech, and less dead space.

29. What are some disadvantages of the nasal mask?
Disadvantages of nasal masks include mouth leaks, less effectiveness with nasal obstruction, nasal irritation, rhinorrhea, and mouth dryness.

30. Full face masks are most often successful in which type of patient?
Full face masks are most often successful in critically ill patients.

31. Which of the following interfaces is used in more than 90% of patients with hypoventilation?
Full face mask

32. Which two interfaces appear to be more efficient at improving ventilation?
Nasal pillows and the full face mask

33. A full face mask surrounds what?
A full face mask surrounds the nose and mouth and rests below the lower lip.

34. What are the landmarks for fitting a full face mask?
The landmarks for a full face mask are below the lower lip with the mouth open, the corners of the mouth, and just below the junction of the nasal bone and cartilage.

35. Should the full face mask fit even if the patient’s mouth is slightly open?
Yes, the full face mask should fit even if the patient’s mouth is slightly open.

36. Which interface that improves ventilation appears to be tolerated the best?
Nasal mask

37. Full face masks are most effective for?
Full face masks are most effective for dyspneic patients.

38. What are some disadvantages of a full face mask?
Disadvantages of full face masks include increased dead space, difficulty in maintaining a seal, increased risk of pressure sores, claustrophobia, increased aspiration risk, difficulty with speech, inability to eat with the mask on, difficulty with secretion clearance, and possible asphyxiation.

39. Nasal pillows or nasal cushions are suitable for patients with what?
Nasal pillows or nasal cushions are suitable for patients with claustrophobia, skin sensitivities, and the need for visibility.

40. How do you properly fit a nasal pillow or nasal cushion?
Properly fit a nasal pillow or nasal cushion using a plastic sizing gauge that is inserted into each nostril.

41. Some leaks may be caused by excessive tension of what?
Excessive tension of the head straps can cause leaks.

42. In order to fit properly, headgear tension should allow what?
Headgear tension should allow 1-2 fingers between the head straps and the face for a proper fit.

43. What should you use for patients without a full set of teeth?
A full face or total face mask can help minimize leaks in patients without a full set of teeth.

44. What strategy should be used when the patient complains of nasal congestion during the use of a nasal mask for NIV?
Add a heated humidifier

45. What are some complications associated with NIV?
Complications associated with NIV include hemodynamic instability, risk of aspiration, claustrophobia, gastric insufflation/distention, difficulty using NG tubes, eye irritation, poor sleep quality, nasal or oral dryness/congestion, sinus or ear pain, and skin problems.

46. What is the typical IPAP setting?
The typical IPAP setting is 8–12 cmH2O, and it can be adjusted to change the tidal volume.

47. What is the typical EPAP setting?
The typical EPAP setting usually starts at 4 cmH2O and can be increased to improve oxygenation.

48. What does the rise time do?
The rise time determines how quickly the ventilator rises from baseline pressure to target pressure.

49. What are the goals of NIV in the acute care setting?
The goals of NIV in the acute care setting are to improve gas exchange, avoid intubation, decrease mortality, decrease the length of time on the ventilator, decrease the length of hospital stay, decrease the chance of ventilator-associated pneumonia, relieve respiratory distress symptoms, improve patient-ventilator synchrony, and maximize patient comfort.

50. Which therapies should be considered the first line of therapy in patients with exacerbated COPD?
Noninvasive ventilation should be considered the first-line therapy for patients with exacerbated COPD.

51. What therapy should be tried first for a patient who has pulmonary edema from left heart failure?
CPAP should be tried first for a patient with pulmonary edema from left heart failure.

52. Which NIV settings are adequate for a patient with cardiogenic pulmonary edema?
Mask CPAP at 8–12 cmH2O with 100% FiO2 is adequate for a patient with cardiogenic pulmonary edema.

53. What are some benefits of CPAP in postoperative abdominal surgery?
CPAP lowers the chances of intubation, pneumonia, and infection/sepsis rates in postoperative abdominal surgery.

54. Which restrictive thoracic diseases are successfully managed with NIV?
Restrictive thoracic diseases successfully managed with NIV include post-polio syndrome, chest wall deformities, neuromuscular diseases, spinal cord injuries, and severe kyphoscoliosis.

55. How does NIV benefit patients with restrictive thoracic diseases?
NIV helps rest inspiratory muscles, lowers CO2, and improves the patient’s compliance, functional residual capacity (FRC), and dead space.

56. Which groups of patients with nocturnal hypoventilation respond to NIV?
Hypercarbic patients with nocturnal hypoventilation respond to NIV.

57. A patient is being ventilated with a nasal mask to relieve dyspnea. This patient has a long history of COPD/hypercarbia. What is the goal of NIV with regard to the ABGs of this patient?
The goal of NIV for this patient is to return the PaCO2 to less than 60 mmHg.

58. What are the contraindications for NIV?
Contraindications for NIV include uncooperative patients, lack of financial resources, non-supportive family, and copious secretions.

59. What two interfaces are most commonly used to apply NIV in the acute care setting?
The nasal mask and full face mask are the two interfaces most commonly used to apply NIV in the acute care setting.

60. Which of the following is a potential risk for overtightening the straps on the mask?
Overtightening the straps on the mask can lead to tissue necrosis.

61. Which ventilators are not used for NIV?
Negative pressure ventilators

62. What are the three characteristics of most NIV ventilators?
(1) Microprocessor controlled, (2) blower driven, and (3) electrically powered

63. What is the most important advantage of NIV over other types of ventilators?
The ability to trigger and cycle when small to moderate air leaks are present

64. What are the required alarms for NIV?
Alarms for battery failure, circuit disconnect, and loss of power

65. What is the current recommendation for adding humidity while using NIV?
It is recommended for long-term patients (longer than a day)

66. What defines the successful application of NIV?
Overall improvement of the patient’s ABG, with an increase in PaO2 and a decrease in PaCO2

67. What physiologic effect does raising the PEEP have on a patient receiving NIV?
An increase in functional residual capacity (FRC)

68. What is the most common complication associated with NIV?
Air leaks

69. What is the recommended initial setting for ventilating pressure when delivering NIV in a pressure-triggered mode?
8–12 cmH2O

70. What is the recommended initial setting for PEEP when delivering NIV in a pressure-triggered mode?
5–8 cmH2O

71. In which hospital settings can NIV be initiated?
NIV can be initiated in any acute care setting, including the emergency department, ICU, and general floor

72. What are the three modes commonly seen on NIV ventilators?
(1) CPAP, (2) Spontaneous (pressure support), and (3) Timed (pressure assist/control)

73. What is required for noninvasive ventilators to work properly?
Continuous air leaks through one or more ports in the ventilator circuit or patient interface

74. What mode of ventilation is most often used for NIV when a critical care ventilator is in use?
Pressure Support Ventilation (PSV)

75. What are the two levels of pressure on a BiPAP?
IPAP and EPAP

76. What is the S/T mode on a BiPAP?
In S/T mode, the patient determines the tidal volume. If the patient does not breathe, the machine cycles to IPAP after a set time has elapsed.

77. What do you set in CPAP mode?
In CPAP mode, the pressure is continuous. The patient breathes on their own and controls their respiratory rate and tidal volume. Only EPAP is set.

78. What are some indications for BiPAP?
Indications for BiPAP include respiratory failure, post-surgical patients, hypoxemia due to hypoventilation, sleep apnea, ventilatory muscle fatigue, upper airway obstruction, and post-extubation difficulties.

79. What are some contraindications for BiPAP?
Contraindications for BiPAP include pre-existing pneumothorax, hypotension, pre-existing lung disease (e.g., emphysema), nosebleeds, risk of aspiration, and sinusitis.

80. What are some side effects of BiPAP?
Side effects of BiPAP include pressure ulcers, claustrophobia, and eye irritation.

81. Why would you adjust IPAP?
To address ventilation problems.

82. Why would you adjust EPAP?
To address oxygenation problems.

83. What is the initial setting for IPAP?
8–12 cmH2O

84. What is the initial setting for EPAP?
3–5 cmH2O

85. What is the initial setting for oxygen on a BiPAP?
You should match the patient’s previous FiO2 or titrate to obtain an acceptable PaO2.

86. If there is an increase in the patient’s PaCO2, what should you do?
Adjust the IPAP to create a greater pressure difference between IPAP and EPAP. This increases alveolar ventilation.

87. What should you do if the patient has hypoxemia?
Increase the level of EPAP.

88. What does the exhalation port do?
It directs air so that the patient exhales through the port, preventing them from rebreathing their CO2.

89. How should the mask fit?
The mask should fit from the bridge of the nose to just below the nares and rest above the upper lip.

89. Which mask likely improves the tidal volume the most?
Full face mask

90. What is EPAP, and how does it help with sleep apnea?
EPAP is similar to CPAP and can be used to improve oxygenation or prevent airway closure in obstructive sleep apnea.

91. What is IPAP, and how does it help with sleep apnea?
When set at a higher pressure than EPAP, IPAP applies positive pressure during the inspiratory phase to maintain a patent airway in obstructive sleep apnea.

92. When using the timed mode of support for NPPV, the patient cannot do what?
Trigger additional mandatory breaths.

93. A patient with uncomplicated obstructive sleep apnea will generally find relief with EPAP pressures of what?
5–10 cmH2O

94. Patients with neuromuscular diseases will usually do well with inspiratory pressures of what?
10–15 cmH2O

95. A maximum pressure of 15–22 cmH2O may be necessary to achieve adequate what?
Alveolar gas exchange

96. During respiratory support, oxygen must be titrated into the mask to achieve what?
A desired FiO2

97. What are the two levels of pressure in BiPAP?
IPAP during inspiration and EPAP during exhalation. The IPAP (ventilation) should be greater than the EPAP (oxygenation).

98. In BiPAP, what is the maximum inspiratory pressure?
22 cmH2O

99. During BiPAP, the ventilator cannot provide adequate support for a patient with what?
High airway resistance or low lung compliance.

100. In BiPAP during operation, the IPAP is the inspiratory pressure needed to do what?
Abolish hypopnea and desaturation.

101. In BiPAP during operation, what does the EPAP represent?
The EPAP is the expiratory pressure needed to keep the airway open.

102. When is BiPAP contraindicated?
BiPAP is contraindicated in patients with dysphagia.

103. If a patient receives NPPV for hypoxemic respiratory failure but does not show signs of improvement, how long should you wait to intubate?
No more than 1-2 hours. If the patient declines within the first 30 minutes, intubate immediately.

104. What three conditions associated with hypoxemic respiratory failure qualify for NPPV as first-line therapy?
Immunocompromised patients, those awaiting transplantation, and post-lung resection patients.

105. What are three other indications for the use of NIV therapy in acute care?
(1) DNI orders, (2) to facilitate weaning for COPD and CHF, and (3) postoperative care in abdominal surgeries.

106. What are five Restrictive Thoracic Diseases (RTD) for which NPPV is used in chronic care?
Post-polio syndrome, chest wall deformities, spinal injuries, severe kyphoscoliosis, and neuromuscular diseases.

107. What are three benefits gained by NPPV in Restrictive Thoracic Diseases?
(1) Improved lung compliance, increased volume/FRC, and reduced dead space, (2) rest for the muscles of inspiration, and (3) lower PaCO2.

108. What three types of ventilators are used for NPPV?
Non-invasive ventilator, critical care ventilator, and portable volume ventilator.

109. What are the four disadvantages of a full-face mask compared to a nasal mask?
(1) Increased dead space, (2) risk of aspiration, (3) claustrophobia, and (4) difficulty communicating.

110. What percentage of acute respiratory failure patients should start with a full face mask?
90%

111. What are the five patient interfaces used with NPPV?
Nasal mask, full face mask, mouthpiece, total face mask, and nasal pillows.

112. What are the exclusion criteria for NPPV in the care of acute respiratory failure?
Copious secretions, hemodynamic instability, apnea, facial burns/trauma, and uncooperative patients.

113. What are the four ways NIV can be provided?
Negative pressure ventilator, positive pressure ventilator, rocking bed, and pneumobelt.

114. How is NPPV typically administered?
Through a nasal or oral/nasal mask.

115.  condition must be present to add NPPV therapy with CPAP in acute pulmonary edema?
Hypercarbia (ventilatory failure)

116. What are the three “constant” end-expiratory pressures that support oxygenation and mean the same thing?
CPAP, EPAP, and PEEP

117. What is the first-line therapy for acute pulmonary edema?
CPAP at 8–12 cmH2O with 100% oxygen

118. What is the standard of care in patients with acute COPD exacerbations?
NPPV (as an alternative to intubation and conventional mechanical ventilation).

119. What are the five goals of NPPV in the chronic care setting?
(1) Avoid hospital admission, (2) increase survival, (3) relieve symptoms, (4) improve mobility, and (5) enhance quality of life.

120. Which mode of ventilation re-establishes FRC and recruits alveoli?
EPAP (or CPAP or PEEP)

121. What five signs of nocturnal hypoventilation must be seen for NPPV therapy to be considered for RTD?
Cognitive dysfunction, headache, fatigue, dyspnea, and daytime hypersomnolence.

122. A 21-year-old man who suffered a C4-5 subluxation injury to the spinal cord needs ventilatory support at night. The patient has skin breakdown at the bridge of his nose. Which of the following interfaces would you select?
Nasal pillows.

123. A 57-year-old woman with a 45-pack-year smoking history and a barrel chest arrives in the emergency department complaining of shortness of breath. She is using pursed-lip breathing. Her arterial blood gas on a 2 L/min nasal cannula is pH = 7.26, PaCO2 = 64 mmHg, PaO2 = 50 mmHg, and HCO3 = 36 mEq/L. Which of the following ventilators would you select?
Noninvasive ventilator

124. All of the following types of patients could benefit from noninvasive positive-pressure ventilation except:
ARDS

125. Noninvasive CPAP is indicated for which of the following?
Acute cardiogenic pulmonary edema with hypoxemia only.

126. The physician recommends a trial of noninvasive ventilation before reintubation. Which of the following ventilators would you plan to use?
Critical care ventilator

127. Which of the following actions will improve patient synchrony during NPPV?
Change the interface to reduce leaks.

128. Which of the following practices would help your patient adjust to NPPV best?
Hold the mask in place with your hands until the patient adjusts to the gas flow.

129. Which of the following statements about noninvasive ventilators is true?
The inner lumen of the circuit must be completely smooth.

130. Which of the following statements about noninvasive ventilatory support is true?
The positive pressure in noninvasive positive-pressure ventilation inflates the patient’s lungs.

131. Which statement related to improving patient comfort with NPPV is correct?
A rise in pressure at the end of inspiration in a pressure-controlled breath indicates an increased work of breathing.

132. What is the Life2000 Ventilator?
The Life2000 ventilator is a lightweight, wearable, noninvasive ventilator designed to support individuals with respiratory conditions that make it challenging to lead an active lifestyle.

133. The use of NIV has increased due to what?
Improved patient interfaces, improved quality of NIV ventilators, NIV software available for critical care ventilators, and reports of success in literature.

134. What is a key point of NIV?
It supports ventilation without an artificial airway.

135. What does NIV encompass?
NIV encompasses both ventilation and CPAP, typically provided by a nasal or oral mask.

136. What is the primary indication for noninvasive ventilation?
Hypercapnic respiratory failure due to COPD. It is the standard of care for managing an acute exacerbation of COPD.

137. What other conditions benefit from NIV?
Asthma, acute cardiogenic pulmonary edema, and hypoxemic respiratory failure.

138. For which other patients should NIV be considered?
NIV should be considered for DNI (Do Not Intubate) patients, postoperative patients, patients needing weaning facilitation (such as those with CHF and COPD), and those with nocturnal hypoventilation.

139. Why do we use NIV for hypercapnic respiratory failure due to COPD?
There is strong evidence that NIV reduces the need for intubation, hospital mortality, and length of stay.

140. What is Inspiratory Positive Airway Pressure (IPAP)?
IPAP is the pressure applied during the inspiratory phase of mechanically assisted ventilation.

Final Thoughts

Noninvasive ventilation is essential in managing various respiratory conditions by providing an effective and less invasive option compared to traditional mechanical ventilation.

Its benefits, including reduced risk of infection, shorter hospital stays, and improved patient comfort, underscore its importance in modern respiratory care.

As technology and techniques continue to advance, the role of NIV in clinical practice will likely expand, offering even greater potential for improving patient outcomes and quality of life.