1. + Non-invasive Positive Pressure Ventilation (NPPV) Basheer Albahrani, RT

2. + Introduction NPPV definition. How does NPPV work? Types of interfaces. Indications and Contraindications to use of NPPV. How to monitor patients on NPPV. practice and cases scenario.

3. + What is NPPV? Noninvasice positive pressure ventilation(NPPV)refers to a form of mechanical ventilation that provides respiratory support without an invasive artificial airway. The potential beneficial effects of NPPV are similar to IMV included : decreased work of breathing,improve oxygenation, and improved gas exchange.

4. + What is NPPV? This type of ventilation avoids many of the complications associated with intubation and IMV for examples:- 1. Ventilator Associated Pneumonia (VAP). 2. Barotrauma, (pneumothorax). 3. Airway and dental injury. 4. laryngeal edema. vocal cord injury. 5. Aspiration. 6. Cardiac arrest.

5. + How Does NPPV Work? CPAP ( Continuous Positive Airway Pressure). A constant level of pressure is applied to the airways throughout the respiratory cycle (inhalation and exhalation). This pressure keeps the large airways open and prevent alveoli from collapsing, thereby avoiding atelectasis and improving oxygenation. CPAP by face mask = PEEP in the intubated patient.

6. + How Does NPPV Work? CPAP ( Continuous Positive Airway Pressure). CPAP is indicated for management of obstructive sleep apnea. CPAP can be used with cardiogenic pulmonary edema If there is hypoxemia BUT no evidence of CO2 retention.

7. + How Does NPPV Work? BiPAP ( Bilevel Positive Airway Pressure). Two positive pressure :- 1. Inspiratory Positive Airway Pressure (IPAP) is the pressure support help patient own inspiration to decrease WOB and increase alveolar ventilation. 2. Expiratory Positive Airway Pressure (EPAP) positive exhalaiton pressure to keep alveoli open during exhalation. EPEP = CPAP = PEEP

8. + How Does NPPV Work? BiPAP ( Bilevel Positive Airway Pressure). The deference between EPAP and IPAP is equal pressure support that can be adjusted to control of Tidal volume Vt and improve ventilation.

9. + Types of interfaces Nasal Mask Face Mask Total face mask

10. + Hypoxemic Respiratory Failure.  cardiogenic pulmonary edema without hemodynamic instability.  Respiratory failure in patients with pneumonia.  Respiratory failure in immunocompromise patients. Hepercapinc Respiratory Failure.  Acute exacerbation of COPD.  Acute exacerbation of Asthma.  Respiratory failure in patients with cystic fibrosis. Indications of NPPV

11. + Contraindications to use of NPPV Cardiac or respiratory arrest. Hemodynamic unstable. Arrhythmias. Patient who is unable to cooperate. Inability to protect the airway. Active upper GI bleeding. Facial trauma and burns. large amount of secretions.

12. + How to monitore patient on NPPV Monitor the patient closely in proper setting. continuous pulse oximetry and cardiac monitoring are suggested. Obtain ABG after 30min of initiation. consider intubation if there is no improvement over the first 4 to 6 hours.

13. +