9In summary Stents airway Recruitment of alveoli Decreases right to left intrapulmonary shuntingDecreases work of breathingOvercomes PEEPiLowers left ventricular transmural pressure reducing afterload and increasing cardiac output
10Who gets NIV? Acute Type 2 Respiratory failure COPD, pH <7.35 despite maximum Rx on controlled O2Cardiogenic pulmonary oedema with hypoxia.Decompensated obstructive sleep apnoea.Chest wall trauma who remain hypoxic. (CPAP)Diffuse pneumonia who remain hypoxic despite maximum Rx (CPAP)Weaning from invasive ventilation.
11Who can’t have NIV? Recent facial or upper airway/upper GI surgery, Facial burns or trauma,Fixed obstruction of the upper airway,Vomiting.Inability to protect the airway,Copious respiratory secretionsLife threatening hypoxaemia,Severe co-morbidity,Confusion/agitation,Bowel obstruction.
19Is ventilation inadequate? Observe chest expansionIncrease target pressure (or IPAP) or volumeConsider increasing inspiratory timeConsider increasing respiratory rate (to increase minute ventilation)Consider a different mode of ventilation/ventilator, if available
20Is the patient synchronising with the ventilator? Observe patientAdjust rate and/or IE ratio (with assist/control)Check inspiratory trigger (if adjustable)Check expiratory trigger (if adjustable)Consider increasing EPAP (with bi-level pressure support in COPD)
21Downside to NIV Horrendous to wear Can’t talk Can’t eat/drink Can’t sleepAgitation, claustrophobiaPoor synchronyDelays intubation
22Final messages Give appropriate oxygen! Non-invasive ventilators just blow airTry to synchronise ventilator to patient i.e. ventilator should support normal ventilationWhen in doubt use CPAPNIV doesn’t work for everyone(30% failure rate)Never forget need for intubation!