Indication and use of Domiciliary NIV

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Presentation transcript:

Indication and use of Domiciliary NIV Laura Bryant Specialist Respiratory Practitioner Wrexham Maelor Hospital 01978 318262 28th November 2016 Laura Bryant 28th November 2016

Laura Bryant 28th November 2016

Laura Bryant 28th November 2016

Laura Bryant 28th November 2016 Aims of session To understand how sleep may affect breathing To provide understanding of patient selection To provide an understanding of the role of NIV (BiPAP) To discuss considerations for patient selection/care/management Laura Bryant 28th November 2016

What happens when we breath? Laura Bryant 28th November 2016

Laura Bryant 28th November 2016

Who may have difficulties? :Obesity :Chest Wall Disease :COPD (LTOT intolerant/multiple admissions) :Neuromuscular Disease Laura Bryant 28th November 2016

Laura Bryant 28th November 2016 What happens? Laura Bryant 28th November 2016

What happens?? Night time.. Laura Bryant 28th November 2016

Laura Bryant 28th November 2016 What happens?? day time... Un refreshing sleep Daytime sleepiness Early morning headaches Swollen ankles Shortness of breath Disturbed sleep Reduced daytime oxygen levels Laura Bryant 28th November 2016

Laura Bryant 28th November 2016

Laura Bryant 28th November 2016 What can we do??? Laura Bryant 28th November 2016

Definition of NIV (B.T.S.) The provision of ventilatory support through the patient’s upper airway using a mask or similar device. CPAP (Continuous Positive Airway Pressure) BiPAP (Bilevel Positive Airway Pressure) BiPAP = pressure on inspiration and expiration Laura Bryant 28th November 2016

Laura Bryant 28th November 2016 When is BiPAP used? Type II Respiratory Failure PaO2 <8 K Pa PaCO2 >6 K Pa Signs of respiratory muscle weakness Signs of nocturnal hypoventilation Associated symptoms Laura Bryant 28th November 2016

Laura Bryant 28th November 2016 What does NIV do? Two levels of respiratory support: IPAP/EPAP Reduce work of breathing Increase tidal volume Improve removal of CO2 Improves oxygenation Reduces symptoms and improves quality of life Laura Bryant 28th November 2016

Laura Bryant 28th November 2016 Why do we do what we do??? Laura Bryant 28th November 2016

What about the practicalities??? Laura Bryant 28th November 2016

Laura Bryant 28th November 2016 Things to consider...... Are there any symptoms??? Diagnosis Patient choice Limb weakness Mask choice Dependency + battery requirements Oxygen requirements Place of residence Laura Bryant 28th November 2016

Laura Bryant 28th November 2016 Practical aspects Patient monitoring Ventilator settings (back up rate) Mask fitting Power failure Mechanical failure Vomiting/choking Disease progression Housework Laura Bryant 28th November 2016

Laura Bryant 28th November 2016 Video clip https://www.google.co.uk/url?url=https://www.youtube.com/watch%3Fv%3DO9tAttK0K1s&rct=j&frm=1&q=&esrc=s&sa=U&ved=0ahUKEwid6Lr6mr_QAhVGBsAKHRJuBbMQtwIIFzAA&usg=AFQjCNE_jQBHOJ1PCi8z8VTicQPtpiaiDQ Laura Bryant 28th November 2016

Laura Bryant 28th November 2016 Summary NIV is an effective treatment for hypoventilation, and some patients can use NIV at home for many years with a good quality of life Its aim is to improve quality of life which is something only the individual can define. Laura Bryant 28th November 2016

Laura Bryant 28th November 2016 Any Questions????? Laura Bryant 28th November 2016