NIV (Non Invasive Ventilation)

NIV should be considered for use in patients with a  persisting Acute Hypercapnic Respiratory Failures after a maximum of one hour of standard medical therapy.

However, ICU should be contacted early if the patient has one of the following:

  • Asthma – Intubation the option of choice in Life threatening
  • Pneumonia – NIV should only be considered as a bridge to intubation
  • No pre-exisiting respiratory issue – NIV not likely helpful
  • pH <7.25 (low threshold for ICU input)
  • pCO2 >6.5kPa (low threshold for ICU input)
  • Type 1 Respiratory Failure (low threshold for ICU input)

Practical

Using NIV – position 45°, correct mask

  • IPAP – Starts 102cms H2O
    • Titrated rapidly by 5cm/15min
    • Target of 20cm H2O or therapeutic
  • EPAP  – 5cm H2O is recommended
  • Oxygen  – to achieve SpO2 of 88-92%
  • ABG’s – after at 1, 4 and 12 hrs [minimum]
  • Intubation decision – within 4 hrs of NIV

Contraindications

  • Recent facial, upper airway or upper gastrointestinal* surgery
  • Fixed obstruction of the upper airway
  • Vomiting
  • Inability to protect the airway*
  • Copious respiratory secretions*
  • Life threatening hypoxaemia*
  • Severe co-morbidity*
  • Confusion/agitation*
  • Bowel obstruction*
  • Pneumothorax [chest drain 1st]

*NIV can be used if contingency plans for tracheal intubation have been made, or if a decision has been made not to proceed to invasive ventilation.

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