Noninvasive ventilation (NIV) is a type of ventilatory support that can be applied without the insertion of an artificial airway. It is indicated for a variety of respiratory conditions, including those that cause acute or chronic respiratory failure.

In this article, we’ll provide an overview of noninvasive ventilation, including its goals, types, indications, contraindication, and complications.

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What is Noninvasive Ventilation?

Noninvasive ventilation is a type of breathing support that applies positive pressure to the patient’s lungs but does not require the insertion of an artificial airway.

It requires an interface, which is a type of mask that creates a tight seal over the patient’s nose or mouth. This allows the machine to force oxygen-rich air into the patient’s lungs using positive pressure.

Goals

The goals of noninvasive ventilation include the following:

  • 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

Noninvasive ventilation will not cure a patient’s initial underlying disease. Instead, it’s meant to provide support until the condition is treated using other means.

Indications

Noninvasive ventilation can be used to treat a variety of respiratory conditions. Some of the most common indications include:

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

Noninvasive ventilation may be indicated for the treatment of a wide range of respiratory conditions. These are just some of the most common examples.

Contraindications

Noninvasive ventilation is not appropriate for all patients. Some 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

If a patient’s condition continues to deteriorate while receiving noninvasive ventilatory support, intubation and mechanical ventilation would be indicated.

Complications

Patients receiving noninvasive ventilation may experience 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

Each patient will experience different complications, if any, based on their individual condition. These are just a few of the most common examples.

Types of Noninvasive Ventilation

There are two primary types of noninvasive ventilation:

  1. Continuous positive airway pressure (CPAP)
  2. Bi-level positive airway pressure (BiPAP)

Each type of noninvasive ventilation has its own unique benefits, indications, and contraindications.

patient noninvasive ventilation

CPAP

Continuous positive airway pressure (CPAP) is a type of noninvasive ventilatory support in which continuous pressure that is greater than atmospheric pressure is maintained throughout the breathing cycle.

There are no mandatory breaths administered during CPAP; therefore, the patient must be breathing spontaneously in order to trigger pressure-supported breaths.

CPAP is often provided to patients with sleep apnea, as it helps keep the airway open to prevent apneic episodes.

BiPAP

Bi-level positive airway pressure (BiPAP) is a type of noninvasive ventilatory support that uses two levels of pressure, including:

  1. IPAP
  2. EPAP

The inspiratory positive airway pressure (IPAP) is a pressure above 0 cmH2O that is applied during the inspiratory phase of breathing.

It works similarly to the peak airway pressure in traditional mechanical ventilation. Therefore, if you increase the IPAP setting, this will increase the delivered tidal volume.

The expiratory positive airway pressure (EPAP) is a pressure above 0 cmH2O that is applied during the expiratory phase of breathing.

It works similarly to PEEP in traditional mechanical ventilation. Therefore, increasing the EPAP setting will improve the patient’s oxygenation.

Note: The primary goal of BiPAP is to reverse acute respiratory failure without the insertion of an artificial airway.

BiPAP vs. CPAP

BiPAP and CPAP are both types of noninvasive ventilation; however, there are some key differences between the two, including:

  • BiPAP delivers two levels of pressure, while CPAP only delivers one.
  • The IPAP and EPAP settings can be adjusted independently in BiPAP, while CPAP only has one level of pressure.
  • BiPAP can improve the patient’s ventilation and oxygenation, while CPAP only improves oxygenation.
  • BiPAP is often used for patients with COPD or heart failure, while CPAP is most often used for patients with sleep apnea.
  • Both can be used during conventional mechanical ventilation; however, it’s important to remember that patients must be able to breathe spontaneously during the administration of CPAP.

Both types of noninvasive ventilation have their own unique benefits and play important roles in the treatment of patients with respiratory conditions.

Interfaces for Noninvasive Ventilation

An interface is a type of mask that covers the nose and/or mouth, which provides a connection between the patient and the machine. There are four primary types:

  1. Nasal mask
  2. Oronasal mask
  3. Nasal pillows
  4. Full-face mask

Each type has its own unique benefits, depending on the needs and preferences of the patient.

Nasal mask

The nasal mask only covers the patient’s nose. This is the most common type of mask worn with CPAP by patients with sleep apnea. This interface is typically tolerated well by most patients.

However, since the mouth isn’t covered with this type of mask, the biggest complication is leakage which often occurs in mouth-breathers. This type can also cause nasal dryness and drainage in some cases.

Oronasal mask

The oronasal mask covers both the mouth and nose. Otherwise, it functions the same as the nasal mask.

Since the mouth is covered with this type of interface, it provides a better seal and leakage isn’t as big of a concern. However, aspiration and regurgitation are potential complications.

Another potential problem is asphyxiation, which could potentially happen if the machine, electricity, or gas source were to fail. However, most masks of this type now have built-in safety valves to prevent this from occurring.

Nasal pillows

Nasal pillows are prongs that fit into the patient’s nose. It looks similar to the nasal mask but is much smaller.

This is the smallest interface; therefore, it’s typically the most comfortable for a high percentage of patients. However, it does come with some complications, including nasal congestion, dry mouth, and nose bleeds.

Like the nasal mask, gas leakage through the mouth is also a potential problem. This is a common interface used in CPAP therapy, but it would not be recommended for BiPAP.

Full-face mask

As its name suggests, the full-face mask covers the entire face. This is the largest interface, which means that it’s also the most uncomfortable for most patients.

A full-face mask is typically indicated when there is significant mouth-breathing by the patient. This often occurs during an acute exacerbation of COPD when a patient is working hard to breathe in as much air as possible.

Noninvasive Ventilation Practice Questions:

1. What is CPAP?
A Constant pressure applied to the spontaneously breathing patient.

2. CPAP is applied via what?
A mask-type device.

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

4. What are some indications for CPAP?
It helps treat obstructive sleep apnea, it improves oxygenation.

5. What does NPPV stand for and what does it do?
NPPV stands for: Noninvasive Positive Pressure Ventilation. Pressure is applied intermittently with inspiration having a higher pressure than expiration.

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6. What are the indications for NPPV?
Acute respiratory failure, and chronic respiratory failure.

7. What does NPPV provide?
It provides greater flexibility in the initiation and removal of mechanical ventilation.

8. What does NPPV permit?
Normal eating, drinking, and also communication with the patient.

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

10. NPPV avoids trauma associated with what?
Intubation, and the complications associated with artificial airways.

11. What does NPPV reduce the risk of?
VAP, ventilator-associated pneumonia.

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

13. NPPV reduces muscle work and helps to what?
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, yes it does.

15. NPPV reduces the requirements of what?
Heavy sedation

16. NPPV reduces the need for what?
Invasive monitoring

17. What does NIV stand for?
Noninvasive ventilation

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

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

20. What are devices that can be used to provide NIV?
Nasal Masks, full face masks, nasal pillows, nasal cushions, total face mask.

21. When fitting the nasal mask you should choose?
The smallest mask without obstructing the nostrils.

22. Where are some anatomic leaks with the nasal mask?
Leaks can occur in the sides of nose bridge above the lip.

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

24. The nasal mask should not be pinching the nose where?
At the side.

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

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

27. What attaches to the end of the mask and rests on the forehead and helps reduce pressure on the bridge of the nose?
Foam bridges

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

29. What are some disadvantages of the nasal mask?
Mouth leak, less effectiveness with nasal obstruction, nasal irritation and rhinorrhea, and mouth dryness.

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

31. The pressure pick off port does what?
It allows a pressure manometer to measure pressure.

32. The ball and socket clip (escape clips) allows for what?
Easy mask removal.

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

34. What are the landmarks for a full mask?
Below the lower lip with the mouth open. Corners of the mouth. Just below the junction of nasal bone and cartilage.

35. Should the full face masks fit even if the patients mouth is slightly open?
Yes, yes it should.

36. You should be sure the mask fits well and does not leak excessively where?
Anywhere really, but particularly in the eyes.

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

38. What are some disadvantages of a full face mask?
Increased deadspace, 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?
Claustrophobia, skin sensitivities, and the need for visibility.

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

41. Some leaks may be caused by excessive tension of what?
The head straps.

41. In order to fit properly, headgear tension should allow?
1-2 fingers between the head straps and the face.

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

43. What are the vented masks for?
They require a vent for exhalation and use only one corrugated tube to connect to the ventilator.

44. What is a characteristic about non-vented masks?
They have both an inspiratory and expiratory line. In a non-vented mask, the exhaled volumes, flows, and pressures can be monitored.

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

46. What is the typical IPAP setting?
It is typically 8 – 12 cmH2O. It can be adjusted to change the tidal volume.

47. What is the typical EPAP setting?
It is usually started out at 4 cmH2O and can be increased in order to improve oxygenation.

48. What does the rise time do?
It determines how fast the vent rises from baseline pressure to target pressure.

49. The high and low-pressure alarm must be set to what in ST mode?
It should be set at +/- 5 in ST mode.

50. The low minute ventilation is usually set at what?
10-20% below patient’s baseline.

51. When will the apnea alarm sound?
When it does not recognize a spontaneous breath.

52. The tidal volume/minute ventilation is a running average of what?
The last 6 breaths.

53. What are the 9 goals of NIV in the acute care setting?
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 sycnhrony, and maximize patient comfort.

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

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

56. Which NIV settings are adequate for a pt with cardiogenic pulmonary edema?
Mask CPAP at 8 – 12 cm H2Ocm and 100% FiO2.

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

58. Which groups of patients are considered at risk for reintubation?
COPD, CHF, hypercapnia.

59. Which restrictive thoracic diseases are successfully managed with NIV?
(1) Post-polio syndrome, (2) Chest wall deformities, (3) Neuromuscular diseases, (4) Spinal cord injuries, and (5) Severe kyphoscoliosis.

60. How does NIV benefit patients with restrictive thoracic diseases?
It helps to rest inspiratory muscles, it helps by lowering CO2, and it improves the patient’s compliance, FRC, and deadspace.

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

62. 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 regards to the ABGs of this patient?
Return the PaCo2 to less than 60 mmHg.

63. What are the 4 contraindications for NIV?
(4) Uncooperative patient, (2) Lack of financial resources, (3) Non-supportive family, and (4) Copious secretions.

64. What 2 interfaces are most commonly used to apply NIV in the acute care setting?
Nasal mask and the Full face mask.

65. Which of the following is a potential risk for overtightening the straps on the mask?
Tissue necrosis

66. Which of the following interfaces is used in greater than 90% of patients with hypoventilation?
Full face Mask

67. Which two interfaces appear to be more efficient to improve ventilation?
Nasal pillows and the full face mask.

68. Which interfaces that improve ventilation appears to be tolerated the best?
Nasal Mask

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

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

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

72. What are the required alarms for NIV?
Battery failure, circuit disconnect, and loss of power.

73. 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.

74. Which is the current recommendation for adding humidity while using NIV?
Recommend it for long-term patients (longer than a day).

75. What defines the successful application of NIV?
Overall improvement of the patient’s ABG. You should be shooting for the PaO2 to increase and the PaCO2 to decrease.

76. What physiologic effect does raising the PEEP have on a patient receiving NIV?
An increased in FRC.

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

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

79. What is the recommended initial setting for ventilating pressure when delivering NIV in a pressure-triggered mode?
8 – 12 cm H20

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

81. Initiating NIV can be done in which hospital settings?
Any acute care setting, the emergency department, the ICU, and of course, on the general floor.

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

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

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

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

86. What is S/T mode on a BiPAP?
The patient determines the tidal volume. If the patient does not breath, the machine cycles to IPAP when time has elapsed.

87. What do you set in CPAP mode?
The pressure is set on continuous. The patient breaths on their own and they are in control of their respiratory rate and tidal volume. You set the EPAP only.

88. List some indications for BiPAP?
Respiratory failure, post-surgical patients, hypoxemia due to hypoventilation, sleep apnea, ventilatory muscle fatigue, upper airway obstruction, and post-extubation difficulties.

89. List some contraindications for BiPAP?
Pre-existing pneumothorax, hypotension, pre-existing lung disease (i.e. emphysema), nose bleeding, aspiration, and sinusitis.

90. What are some side effects of BiPAP?
Pressure ulcers, claustophobia, and eye irritiation.

91. Why would you adjust IPAP?
For ventilation problems.

92. Why would you adjust EPAP?
For oxygenation problems.

93. What is the IPAP initial setting?
8 – 12 cmH20

94. What is the EPAP initial setting?
3 – 5 cmH20

95. 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.

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

97. What would you do if the patient has hypoxemia?
Increase the level of EPAP.

98. What does the exhalation port do?
If directs air. The patient exhales through the port that they do not rebreath their CO2.

99. How should the mask fit?
From the bridge of the nose to just below the nares. Make sure the mask rests above the upper lip.

100. For a CPAP machine, describe the pressure?
It will be constant during inhalation and exhalation.

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

102. What is EPAP and how does it help with sleep apnea?
It is the same as CPAP and can be used to improve oxygenation or prevent airway closure in obstructive sleep apnea.

103. What is IPAP and how does it help with sleep apnea?
When this mode is set at a higher pressure than the EPAP, positive pressure will be applied during the inspiratory phase. This will maintain a patent airway in obstructive sleep apnea.

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

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

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

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

108. During respiratory support, oxygen must be titrated into the mask to achieve what?
A desired FIO2

109. What are the two levels of CPAP in BIPAP?
IPAP during inspiration, EPAP during exhalation. The IPAP (ventilation) should be greater than the EPAP (oxygenation).

110. Describe BIPAP ventilator breaths?
They are flow triggered and require patient effort to be greater than 40 ml/sec to initiate an inspiration.

111. In BIPAP, what I:E ratio is preferred?
1:2

112. In BIPAP, what is the maximum inspiratory pressure?
22 cm H2O

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

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

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

116. When is BIPAP contraindicated?
On a patient with dysphagia.

117. 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, don’t wait any longer.

118. What 3 conditions are associated with hypoxemic respiratory failure qualify for NPPV as first line therapy?
Immunocompromised, those awaiting transplantation, and post lung resection.

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

120. What are 5 Restrictive Thoracic Diseases (RTD) for which NPPV is used in chronic care?
Post-polio, chest wall deformities, spinal injuries, severe kyphoscoliosis, and neuromuscular disease.

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

122. What 3 types of ventilators are used for NPPV?
Non-invasive Ventilator, Critical Care Ventilator, and Portable Volume Ventilator.

123. What are 4 disadvantages of a full face mask vs. a nasal mask?
(1) Increased dead space, (2) risk of aspiration, (3) claustrophobia, and (4) difficult to communicate.

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

125. What are the 5 patient Interfaces used with NPPV?
Nasal mask, full face mask, mouth piece, total face mask, and nasal pillows.

126. What is the exclusion criteria for NPPV in care of Acute Respiratory Failure?
Copious secretions, hemodynamic instability, apnea, face burns/trauma, and uncooperative patients.

127. What are the 4 ways NIV can be provided?
Negative Pressure Ventilator, Positive Pressure Ventilator, Rocking Bed, and a Pneumobelt.

128. How is NPPV typically administered?
Nasal or oral/nasal mask.

129. What condition must be present to add NPPV therapy with CPAP in Acute Pulmonary Edema?
Hypercarbia (ventilatory failure).

130. What are the 3 “constant” end expiratory pressures that support oxygenation and they all mean the same thing?
CPAP, EPAP, and PEEP.

131. What is the first line therapy for Acute Pulmonary Edema?
CPAP 8-12 cmH2O with 100% oxygen.

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

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

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

135. What 5 nocturnal hypoventilation signs must be seen for NPPV therapy to be considered for RTD?
Cognitive dysfunction, headache, fatigue, dyspnea, and daytime hypersomnolence.

136. A 21-year-old men 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.

137. 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 2L/min nasal cannula is pH = 7.26 , PaCO2=64mmHg, PaO2=50mmHg, and HCO3=36mEq/L. Which of the following ventilators would you select?
Noninvasive ventilator.

138. A 67-year-old man had a surgical repair for a perforated gallbladder with peritonitis one week ago. He was extubated earlier in the day, but he presently has a respiratory rate of 32 breaths/min, is diaphoretic, and is using accessory muscles to breath. His ABGS on 60% O2 aerosol is pH= 7.40 PaCO2= 31mmHg PaO2= 71mmHg and HCO3= 19mEq/L. Which of the following action is most appropriate?
Intubate the patient if there is not significant improvement within 1 to 2 hours

139. After Mr. Pierre adjusts to the initial feel of NPPV, which of the following settings would you like to achieve?
IPAP= 10cm H2O, EPAP= 8cm H2O FiO2= 0.50

140. After Mr. Pierre is breathing for 10 minutes on his new NPPV settings, you see the following image on his ventilator graphics. Which of the following changes would you make?
Adjust the termination of flow.

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

142. Mr. Pierre has been on his NPPV for the past 2 hours. His respiratory rate is 26 breaths/ min with moderate accessory muscle use. After viewing his arterial blood gas values on FiO2= 0.50, which of the following would you recommend?
Re-intubate and use invasive ventilation.

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

144. The physician recommends a trial of noninvasive ventilation before reintubation. Which of the following ventilators would you plan to use?
Critical care ventilator.
145. Where would you set the initial IPAP and EPAP levels as you help Mr. Pierre adjust to the NPPV?
IPAP= 4cm H2O, EPAP= 2cm H2O

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

147. Which of the following best describes the type of respiratory problem Mr. Pierre is likely experiencing?
Hypoxemia respiratory failure.

148. 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.

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

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

151. 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.

152. Which type of interface would you select for Mr. Pierre?
Total face mask.

153. How is noninvasive ventilation abbreviated?
NIV or NPPV.

154. 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.

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

156. What does NIV encompass?
Ventilation and CPAP — typically provided by a nasal or oral mask.

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157. 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.

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

159. What other patients should NIV be considered for?
DNI (Do not intubate) patients, postoperative patients, patients in need of weaning facilitation (CHF and COPD patients), and those with nocturnal hypoventilation.

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

161. What is hypoxemic respiratory failure?
The inability to maintain the normal oxygenation in the arterial blood. It may be indicated by a PaO2 of less that 60 mm Hg in an individual breathing supplemental oxygen.

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

Final Thoughts

Noninvasive ventilation is a type of mechanical ventilation that doesn’t require the placement of an artificial airway. This includes BiPAP and CPAP, which both have their own unique benefits.

The primary goal of NIV is to provide breathing support while avoiding the complications that can come from intubation and conventional mechanical ventilation.

Respiratory therapists are responsible for initiating NIV, providing education on its use, and making adjustments to the settings as needed. That is why this is such an important topic.

Be sure to read our guide on the basics of mechanical ventilation to expand your knowledge even further on providing ventilatory support. Thanks for reading!

Medical Disclaimer: This content is for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Please consult with a physician with any questions that you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you read in this article. We strive for 100% accuracy, but errors may occur, and medications, protocols, and treatment methods may change over time.

References

The following are the sources that were used while doing research for this article:

  • Chang, David. Clinical Application of Mechanical Ventilation. 4th ed., Cengage Learning, 2013. [Link]
  • Rrt, Cairo J. PhD. Pilbeam’s Mechanical Ventilation: Physiological and Clinical Applications. 7th ed., Mosby, 2019. [Link]
  • Faarc, Kacmarek Robert PhD Rrt, et al. Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020. [Link]
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