NIV oncall

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Information about NIV oncall

Published on May 1, 2008

Author: Heather


Non Invasive Ventilation:  Non Invasive Ventilation What is it? What is it?:  What is it? Respiratory support given without an endotracheal tube Spontaneously breathing patients Normal Breathing:  Normal Breathing negative pressure air is drawn in when the diaphragm descends 3 types: :  3 types: IPPB Intermittent Positive Pressure Breathing CPAP Continuous Positive Airways Pressure BiPAP Bi-level Positive Airways Pressure CPAP:  CPAP High flow oxygen + PEEP Wispaflow Dräger Raises FRC away from residual volume Splints alveoli open:  work of breathing  PaO2 re-expand atelectasis Helps resolution of pulmonary oedema Lung Capacities:  Lung Capacities Maximal inspiration Maximal expiration TV RV FRC Resting expiratory level Closing Volume and Functional Residual Capacity:  Closing Volume and Functional Residual Capacity Increased CV Decreased FRC FRC CV FRC – Functional Residual Capacity CV – Closing Volume BiPAP:  BiPAP IPAP + EPAP EPAP = PEEP Inspiratory pressure increases tidal volume  PaCO2  PaO2  work of breathing and fatigue Terminology:  Terminology IPAP EPAP Pressure Support 0 4 8 12 16 CPAP or BiPAP?:  CPAP or BiPAP? Respiratory Failure:  Respiratory Failure Type I low PaO2 < 8 kPa all else normal Type II low PaO2 high PaCO2 ABGs:  ABGs Normal Values pH 7.35 - 7.45 PaO2 10.7 - 13.3 kPa PaCO2 5.6 - 6.7 kPa HCO3- 22 - 26 mmol BE -2 - +2 Slide13:  Type I Failure Hypoxia CPAP Type II Failure Hypercapnia Hypoxia BiPAP Slide14:  group work Clinical benefits:  Clinical benefits Acute Type I respiratory failure Type II respiratory failure Pulmonary oedema Sub-acute Weaning Post-extubation Chronic Sleep apnoea Type II respiratory failure COPD CF Neuromuscular diease Precautions:  Precautions Impaired consciousness Confusion/agitation CXR showing consolidation Drained pneumothorax Copious secretions Inability to protect airway Haemodynamic instability Recent upper GI surgery or bowel obstruction Contraindications:  Contraindications Need for immediate intubation Facial trauma/burns Frequent vomiting Recent facial/upper airway surgery Undrained pneumothorax Advantages of avoiding intubation:  Advantages of avoiding intubation No paralysis or sedation Ability to move – pressure relief Able to communicate Able to eat and drink Self care Less need for invasive monitoring Less risk of infection Slide19:  No endotracheal tube  infection risk No tracheal damage Able to communicate Decreased need for ITU Cost Patient and carer experience Less debilitating Implications for Physiotherapy:  Implications for Physiotherapy Mask fitting Deoxygenation Expectoration Familiarity with machines/alarms Skills needed:  Skills needed Patient handling/communication Knowledge of respiratory physiology Familiarity with interfaces Knowledge of pressure area care Time to spend with patient Patience Beware!:  Beware! ‘CPAP’ mode on ITU ventilators Spontaneous breathing mode IP + PEEP

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