2What is NIV?Non-Invasive Positive Pressure Ventilation (NPPV) refers to the provision of ventilatory support through the patient’s upper airway using a mask or similar deviceNIV should be available 24 hours a day in hospitals admitting patients in acute hypercapnic respiratory failure (British Thoracic Society, 2002)Different types of NIV include High Flow Oxygen Therapy (HFT), Continuous Positive Airway Pressure (CPAP), pressure controlled ventilation (more commonly known as BiPAP) and volume controlled ventilation (not often used in children)
3When to use NIVMay be used for both acute and chronic respiratory problemsMay be used both at home and in the hospital settingIn an acute setting, the commencement of therapy is usually dictated by the patient’s work of breathing, blood gases and oxygen requirementsChronic use will be dictated by sleep studies and individual need and condition
4Conditions that NIV is commonly used for Acute conditionsBronchiolitisPertussisPneumoniaChronic conditionsCentral HypoventilationDuchenne’s muscular dystrophySMA (Spinal Muscular Atrophy)Tracheomalacia and bronchomalacia
5What does NIV do?Used to overcome mechanical problems with the airway,lungs or chest wallRest fatigued inspiratory musclesSupport upper airway collapseTo regulate gas exchangeNormalise CO2 levelsTreat acidosisIncrease oxygenation and reverse hypoxiaTo increase lung volumeTreat hypoxemic respiratory failurePrevent/treat atelectasisIncrease PEEPOptimise work of breathing
6Types of NIV used at JR High flow oxygen therapy OptiflowVapothermThis delivers a flow of warmed gas that exceeds the patients respiratory demand so facilitating flushing of the dead space of the upper airway.CPAP is not provided however it is thought that a 5-8cmH2O pressure may be acheived in some patients.
7Types of NIV used at JR Advantages of HFT Patient compliance will be similar to that as when using nasal cannula oxygen therapy.Minimal risk of pressure areas developing.Disadvantages of HFTGases need to be humidified to body temperature with 100% relative humidity therefore requiring the equipment to facilitate this.
8Types of NIV used at JR Continuous positive airway pressure (CPAP) CPAP drivers including SiPAPV60 and TrilogyNIPPYThis provides positive airway pressure throughout the breathing cycle, restoring functional residual capacity to prevent collapse and lessen work of breathing
9Types of NIV used at JR Advantages of CPAP Can be used for spontaneously breathing patientsDisadvantages of CPAPCompliance may be poorPatient must have an intact respiratory drive as there is no backup rateIncreased risk of pressure areas developingSpecialist equipment needs to be used to deliver the pressure and monitor it adequately
10Types of NIV used at JR BiPAP V60 AND TrilogyNIPPYThis provides positive pressure throughout the breathing cycle with a higher pressure delivered during inspirationThis results in reduced work of breathing and improvement in tidal volume and CO2 removal
11Types of NIV used at JR Advantages Improves work of breathing so decreasing respiratory effortMost equipment will support spontaneously breathing patients as well as delivering breaths for patients that are having apnoeasDisadvantagesCompliance may be poorIncreased risk of pressure areas developingSpecialist equipment needs to be used to deliver the pressure and monitor it adequately