Download study guide for class about modelities and more Summaries English in PDF only on Docsity!
Comprehensive Study Guide: Noninvasive Ventilation
(NIV)
1. Definition and Overview
● NIV : Provides ventilatory support without an artificial airway (ETT or tracheostomy).
● Includes:
○ NPPV (Noninvasive Positive Pressure Ventilation) – most common.
○ CPAP (Continuous Positive Airway Pressure) – maintains constant pressure.
2. Goals and Benefits of NIV
Acute Care Goals
● Improve gas exchange (↑ PaO₂, ↓ PaCO₂)
● Avoid intubation
● Decrease mortality and hospital stay
● Reduce VAP incidence
● Relieve dyspnea and distress
● Improve synchrony and comfort
Long-Term Goals
● Relieve symptoms
● Enhance quality of life
● Avoid hospitalization
● Improve survival and mobility
3. Indications for NIV
A. Acute Care Indications
Disorder Role of NIV Notes
COPD Exacerbation ✅ First-line
↓ Intubation, ↓
mortality
Asthma ⚠️ Controversial
Limited evidence
Cardiogenic Pulmonary Edema ✅ CPAP 8–12 cmH₂O,
100% O₂
Improves oxygenation
Hypoxemic Respiratory Failure
(ARDS/ALI)
⚠️ Not routine Fail if PaO /FiO₂ ₂<
after 1 hr
Pneumonia Limited benefit Only for COPD +
pneumonia
Immunosuppressed/Post-Op ✅ Useful ↓ Intubation,
mortality
B. Long-Term Care Indications
Disorder NIV Use Notes
Nocturnal Hypoventilation ✅ COPD, OHS, NMD,
Kyphoscoliosis
Restrictive Thoracic Disease (ALS,
Kyphoscoliosis)
✅ Start when nocturnal
hypoventilation appears
Stable COPD ⚠️ Limited
evidence
May improve gas exchange
Obesity Hypoventilation (OHS) ✅ Use NPPV if CPAP fails
4. Patient Selection
Acute Respiratory Failure – Criteria
At least 2 of the following:
● Use of accessory muscles or paradoxical breathing
Nasal mask Chronic/Night use More comfortable
Helmet / Nasal pillows / Mouthpiece Less common May help long-term users
Avoid overtightening → prevent skin necrosis.
7. Ventilator Types
● Noninvasive Ventilators: Leak compensation, IPAP/EPAP modes.
● Critical Care Ventilators: Precise control but poor leak tolerance.
● Portable/Home Care Ventilators: Battery powered; for transport or long-term use.
8. Initial NIV Settings
Parameter Initial Setting Adjust to...
PEEP (EPAP) 0–4 cmH O₂ Improve oxygenation / asynchrony
IPAP 2–4 cmH O above₂
EPAP
Titrate to VT ≈ 4–6 mL/kg
PBW
FiO₂ Adjust for SpO ₂ > 90% Avoid hyperoxia
Increase gradually as tolerated.
9. Assessing NIV Success
● Improved ABGs : ↓ PaCO₂, ↑ pH, ↑ PaO₂
● ↓ RR, ↓ accessory muscle use, ↑ Vt
● Clinical improvement within 1–2 hours
Failure: Worsening ABGs, distress, no improvement → Intubate immediately
10. Adjustments
Problem Intervention
PaCO₂
↑ IPAP (VT) or ↑
Rate
PaCO₂
↓ IPAP (VT) or ↓
Rate
↑ PaO₂ ↑ FiO₂ or ↑ EPAP
↓ PaO₂ ↓ FiO₂ or ↓ EPAP
11. Monitoring
● Leaks, synchrony, comfort
● ABG trends
● Vital signs, SpO₂
● Watch for deterioration → Intubate if needed
12. Adverse Effects
● Mask discomfort or necrosis
● Air leaks → asynchrony, poor ventilation
● Aerophagia, sinus pain
● Aspiration, hypotension, pneumothorax (rare)
13. Role of the RT
● Assess for candidacy
● Proper interface fitting
C. Allow patient to hold mask before strapping it on
D. Increase FiO ₂to 100%
5. After 1 hour of NIV, ABG shows PaCO ₂unchanged and pH remains low.
The patient’s RR is still 30/min. Next step?
A. Continue NIV and reassess in 2 hours
B. Increase EPAP by 2 cmH O₂
C. Intubate and initiate invasive ventilation
D. Add heated humidification
6. Which of the following adjustments will improve oxygenation in NIV?
A. Increase IPAP
B. Decrease EPAP
C. Increase EPAP
D. Decrease FiO₂
7. Which complication is most directly associated with excessive mask
tightening?
A. Aspiration
B. Skin necrosis
C. Aerophagia
D. Barotrauma
8. A patient receiving NIV for cardiogenic pulmonary edema should be
started on:
A. CPAP 5 cmH O, 40% O₂ ₂
B. CPAP 10 cmH O, 100% O₂ ₂
C. IPAP 12, EPAP 6 cmH O₂
D. SIMV 12/min, VT 450 mL
9. A COPD patient on NIV has a high PaCO. What adjustment should be₂
made first?
A. Increase IPAP
B. Decrease IPAP
C. Increase EPAP
D. Increase FiO₂
10. Which of the following is not a major cause of NIV failure?
A. Large air leak
B. Asynchrony
C. Patient cooperation
D. High PaO₂
✅ Answer Key (Separate Page)
- B – BiPAP improves ventilation, reduces PaCO .₂
- B – Early improvement in gas exchange = success.
- C – Apneic patients require airway protection → intubation.
- C – Helps patient acclimate; prevents panic.
- C – Failure after 1–2 hrs → intubate.
- C – Increasing EPAP ↑ mean airway pressure, improves oxygenation.
- B – Excess pressure → tissue ischemia and necrosis.
- B – CPAP 8–12 cmH O + 100% O₂ ₂= first-line CHF management.
- A – Increasing IPAP ↑ VT, ↓ PaCO₂.
- D – High PaO ₂doesn’t cause NIV failure.
