Noninvasive ventilation: Difference between revisions
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**Improves lung compliance and V/Q matching. | **Improves lung compliance and V/Q matching. | ||
**Decreases the work of breathing. | **Decreases the work of breathing. | ||
*Reduces need for [[intubation]] and mortality in acute cardiogenic [[pulmonary edema]]<ref>Peter JV, Moran JL, Phillips-Hughes J, Graham P, Bersten AD. Effect of non-invasive positive pressure ventilation (NIPPV) on mortality in patients with acute cardiogenic pulmonary oedema: a meta-analysis. Lancet. 2006;367(9517):1155-1163. doi:10.1016/S0140-6736(06)68506-1</ref> and acute [[COPD exacerbation]]<ref>Ambrosino N, Vagheggini G. Non-invasive ventilation in exacerbations of COPD. Int J Chron Obstruct Pulmon Dis. 2007;2(4):471-476.</ref> | |||
===CPAP vs. BPAP=== | ===CPAP vs. BPAP=== | ||
[[File:CPAPvsBiPAP.jpg|thumb|Illustration of difference between CPAP and BPAP.]] | |||
*CPAP = PEEP = EPAP | *CPAP = PEEP = EPAP | ||
**Use for isolated hypoxia | |||
**Increasing CPAP increases oxygenation | |||
*BPAP = PEEP + (IPAP = Inspiratory Pressure Support) | *BPAP = PEEP + (IPAP = Inspiratory Pressure Support) | ||
**Note: BiPAP is a brand name of one of the BPAP machines. Both names are often used interchangeably. | **Use for hypoxia and hypoventilation (decreases work of breathing) | ||
**Increasing IPAP (specifically IPAP-CPAP) increases ventilation | |||
***Note: BiPAP is a brand name of one of the BPAP machines. Both names are often used interchangeably. | |||
==Indications== | ==Indications== | ||
*CHF | *[[CHF]] | ||
*COPD | *[[COPD]] | ||
*Asthma | *[[Asthma]] | ||
*OSA | *OSA | ||
*Pulmonary edema | *[[Pulmonary edema]] | ||
*Pneumonia | *[[Pneumonia]] | ||
==Contraindications== | ==Contraindications== | ||
| Line 31: | Line 37: | ||
==Procedure== | ==Procedure== | ||
[[File:BIPAP.png|thumb|Patient on BPAP.]] | |||
[[File:CPAP continuous positive airway pressure mask installed.jpg|thumb|CPAP mask on EMS manikin.]] | |||
[[File:Cpapanwender.jpg|thumb|Home CPAP device.]] | |||
#Prepare intubation equipment in case of BPAP/CPAP failure. | #Prepare intubation equipment in case of BPAP/CPAP failure. | ||
#Position the patient in a 30-90° upright position. | #Position the patient in a 30-90° upright position. | ||
| Line 39: | Line 48: | ||
#Prepare the patient. | #Prepare the patient. | ||
#*Patients will often require frequent coaching throughout this process. | #*Patients will often require frequent coaching throughout this process. | ||
#*In moderately anxious patients, consider a benzodiazepine or | #*In moderately anxious patients, consider low-dose [[fentanyl]], a [[benzodiazepine]] or [[ketamine]] to assist with patient-ventilator synchrony. | ||
#Adjust the settings. | #Adjust the settings. | ||
#*For BPAP, begin with an IPAP of 8-10 cm H2O and an EPAP of 2-4 cm H2O. | #*For BPAP, begin with an IPAP of 8-10 cm H2O and an EPAP of 2-4 cm H2O. | ||
| Line 56: | Line 65: | ||
==See Also== | ==See Also== | ||
{{Mechanical ventilation pages}} | |||
== | ==External Links== | ||
*[https://www.merckmanuals.com/professional/critical-care-medicine/how-to-do-other-airway-procedures/how-to-do-noninvasive-positive-pressure-ventilation?query=noninvasive%20ventilation Merk Manual - How To Do Noninvasive Positive Pressure Ventilation] | |||
*[https://www.nuemblog.com/blog/nippv NUEM - Non-Invasive Positive Pressure Ventilation in the ED] | |||
==References== | |||
<references/> | |||
[[Category:Critical Care]] | [[Category:Critical Care]] | ||
[[Category: | [[Category:Pulmonary]] | ||
Latest revision as of 17:32, 10 April 2024
Background
Mechanism of Action
- Augments inspiratory/expiratory pressures throughout a spontaneous respiratory cycle.
- Recruits compressed alveoli to reduce atelectasis.
- Prevents small airway collapse during inspiration.
- Counteracts intrinsic PEEP (Positive End Expiratory Pressure).
- Decreased both preload and afterload in heart failure exacerbations.
- Improves lung compliance and V/Q matching.
- Decreases the work of breathing.
- Reduces need for intubation and mortality in acute cardiogenic pulmonary edema[1] and acute COPD exacerbation[2]
CPAP vs. BPAP
- CPAP = PEEP = EPAP
- Use for isolated hypoxia
- Increasing CPAP increases oxygenation
- BPAP = PEEP + (IPAP = Inspiratory Pressure Support)
- Use for hypoxia and hypoventilation (decreases work of breathing)
- Increasing IPAP (specifically IPAP-CPAP) increases ventilation
- Note: BiPAP is a brand name of one of the BPAP machines. Both names are often used interchangeably.
Indications
Contraindications
- Obtunded patients
- Uncooperative patients
- Vomiting or inability to protect the airway (aspiration risk)
- Facial trauma or burns
- Facial, esophageal, or gastric surgery
- Poor mask fit
Procedure
- Prepare intubation equipment in case of BPAP/CPAP failure.
- Position the patient in a 30-90° upright position.
- Apply the mask.
- Select the appropriately-sized mask.
- Secure it in place by fastening the Velcro straps.
- Note: Some experts recommend allowing the patient to get used to the mask first, PRIOR TO starting the positive airway pressures.
- Prepare the patient.
- Patients will often require frequent coaching throughout this process.
- In moderately anxious patients, consider low-dose fentanyl, a benzodiazepine or ketamine to assist with patient-ventilator synchrony.
- Adjust the settings.
- For BPAP, begin with an IPAP of 8-10 cm H2O and an EPAP of 2-4 cm H2O.
- Gradually titrate upward IPAP and EPAP 1-2 cm every 5-15 minutes with a goal IPAP 10-16 cm H2O and EPAP of 8-10 cm H2O depending upon patient response.
- Continue close monitoring.
- A doctor, nurse, or respiratory therapist should be with the patient at all times during BPAP/CPAP use.
Complications
- Skin irritation
- Nasal bridge pain
- Mucosal dryness
- Eye irritation
- Gastric distention
- Decreased cardiac output
- Barotrauma (rarely)
See Also
Mechanical Ventilation Pages
- Noninvasive ventilation
- Intubation
- Mechanical ventilation (main)
- Miscellaneous
External Links
- Merk Manual - How To Do Noninvasive Positive Pressure Ventilation
- NUEM - Non-Invasive Positive Pressure Ventilation in the ED
References
- ↑ Peter JV, Moran JL, Phillips-Hughes J, Graham P, Bersten AD. Effect of non-invasive positive pressure ventilation (NIPPV) on mortality in patients with acute cardiogenic pulmonary oedema: a meta-analysis. Lancet. 2006;367(9517):1155-1163. doi:10.1016/S0140-6736(06)68506-1
- ↑ Ambrosino N, Vagheggini G. Non-invasive ventilation in exacerbations of COPD. Int J Chron Obstruct Pulmon Dis. 2007;2(4):471-476.