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Non-invasive Ventilation. What is NIV? Non-Invasive Positive Pressure Ventilation (NPPV) refers to the provision of ventilatory support through the patients.

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Presentation on theme: "Non-invasive Ventilation. What is NIV? Non-Invasive Positive Pressure Ventilation (NPPV) refers to the provision of ventilatory support through the patients."— Presentation transcript:

1 Non-invasive Ventilation

2 What is NIV? Non-Invasive Positive Pressure Ventilation (NPPV) refers to the provision of ventilatory support through the patients upper airway using a mask or similar device Non-Invasive Positive Pressure Ventilation (NPPV) refers to the provision of ventilatory support through the patients upper airway using a mask or similar device NIV should be available 24 hours a day in hospitals admitting patients in acute hypercapnic respiratory failure (British Thoracic Society, 2002)NIV 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)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)

3 When to use NIV May be used for both acute and chronic respiratory problems May be used for both acute and chronic respiratory problems May be used both at home and in the hospital setting May be used both at home and in the hospital setting In an acute setting, the commencement of therapy is usually dictated by the patients work of breathing, blood gases and oxygen requirements In an acute setting, the commencement of therapy is usually dictated by the patients work of breathing, blood gases and oxygen requirements Chronic use will be dictated by sleep studies and individual need and condition Chronic use will be dictated by sleep studies and individual need and condition

4 Conditions that NIV is commonly used for Acute conditions Bronchiolitis Bronchiolitis Pertussis Pertussis Pneumonia Pneumonia Chronic conditions Central Hypoventilation Central Hypoventilation Duchennes muscular dystrophy Duchennes muscular dystrophy SMA (Spinal Muscular Atrophy) SMA (Spinal Muscular Atrophy) Tracheomalacia and bronchomalacia Tracheomalacia and bronchomalacia

5 What does NIV do? Used to overcome mechanical problems with the airway,lungs or chest wall Used to overcome mechanical problems with the airway,lungs or chest wall –Rest fatigued inspiratory muscles –Support upper airway collapse To regulate gas exchange To regulate gas exchange –Normalise CO2 levels –Treat acidosis –Increase oxygenation and reverse hypoxia To increase lung volume To increase lung volume –Treat hypoxemic respiratory failure –Prevent/treat atelectasis –Increase PEEP Optimise work of breathing Optimise work of breathing

6 Types of NIV used at JR High flow oxygen therapy High flow oxygen therapy –Optiflow –Vapotherm This delivers a flow of warmed gas that exceeds the patients respiratory demand so facilitating flushing of the dead space of the upper airway. This 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 5-8cmH 2 O pressure may be acheived in some patients. CPAP is not provided however it is thought that a 5-8cmH 2 O pressure may be acheived in some patients.

7 Types of NIV used at JR Advantages of HFT Advantages of HFT Patient compliance will be similar to that as when using nasal cannula oxygen therapy. Patient compliance will be similar to that as when using nasal cannula oxygen therapy. Minimal risk of pressure areas developing. Minimal risk of pressure areas developing. Disadvantages of HFT Disadvantages of HFT Gases need to be humidified to body temperature with 100% relative humidity therefore requiring the equipment to facilitate this. Gases need to be humidified to body temperature with 100% relative humidity therefore requiring the equipment to facilitate this.

8 Types of NIV used at JR Continuous positive airway pressure (CPAP) –CPAP drivers including SiPAP –V60 and Trilogy –NIPPY This provides positive airway pressure throughout the breathing cycle, restoring functional residual capacity to prevent collapse and lessen work of breathing This provides positive airway pressure throughout the breathing cycle, restoring functional residual capacity to prevent collapse and lessen work of breathing

9 Types of NIV used at JR Advantages of CPAP Advantages of CPAP Can be used for spontaneously breathing patients Can be used for spontaneously breathing patients Disadvantages of CPAP Disadvantages of CPAP Compliance may be poor Compliance may be poor Patient must have an intact respiratory drive as there is no backup rate Patient must have an intact respiratory drive as there is no backup rate Increased risk of pressure areas developing Increased risk of pressure areas developing Specialist equipment needs to be used to deliver the pressure and monitor it adequately Specialist equipment needs to be used to deliver the pressure and monitor it adequately

10 Types of NIV used at JR BiPAP –V60 AND Trilogy –NIPPY This provides positive pressure throughout the breathing cycle with a higher pressure delivered during inspiration This provides positive pressure throughout the breathing cycle with a higher pressure delivered during inspiration This results in reduced work of breathing and improvement in tidal volume and CO2 removal This results in reduced work of breathing and improvement in tidal volume and CO2 removal

11 Types of NIV used at JR Advantages Improves work of breathing so decreasing respiratory effort Improves work of breathing so decreasing respiratory effort Most equipment will support spontaneously breathing patients as well as delivering breaths for patients that are having apnoeas Most equipment will support spontaneously breathing patients as well as delivering breaths for patients that are having apnoeasDisadvantages Compliance may be poor Compliance may be poor Increased risk of pressure areas developing Increased risk of pressure areas developing Specialist equipment needs to be used to deliver the pressure and monitor it adequately Specialist equipment needs to be used to deliver the pressure and monitor it adequately

12 Terminology EPAP/CPAP/PEEP EPAP/CPAP/PEEP –Expiratory positive airway pressure –Continuous positive airway pressure –Positive end expiratory pressure IPAP/PIP IPAP/PIP –Inspiratory positive airway pressure –Positive inspiratory pressure iT/Ti iT/Ti –Inspiratory time Backup rate Backup rate Tidal volume/TV/VTi/VTe Tidal volume/TV/VTi/VTe Minute volume/MV/Min vent Minute volume/MV/Min vent MAP MAP –Mean airway pressure

13 Contraindications Craniofacial trauma or burns Craniofacial trauma or burns Basal skull fractures Basal skull fractures Recent facial, oesophageal or gastric surgery Recent facial, oesophageal or gastric surgery Uncooperative patient Uncooperative patient Consider whether NIV is the best option Consider whether NIV is the best option

14 Care of a child on NIV Consent Consent Child and family support/education Child and family support/education Pressure area care Pressure area care NGT NGT IVI IVI Secretion clearance Secretion clearance

15 Any questions?

16 Time for NIV


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