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

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4. 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

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

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7. Who may have difficulties?
:Obesity
:Chest Wall Disease
:COPD (LTOT intolerant/multiple admissions)
:Neuromuscular Disease
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What happens?
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9. What happens?? Night time..
Laura Bryant 28th November 2016

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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

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

13. 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

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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
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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

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

17. What about the practicalities???
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Things to consider......
Are there any symptoms???
Diagnosis
Patient choice
Limb weakness
Mask choice
Dependency + battery requirements
Oxygen requirements
Place of residence
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Practical aspects
Patient monitoring
Ventilator settings (back up rate)
Mask fitting
Power failure
Mechanical failure
Vomiting/choking
Disease progression
Housework
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Video clip
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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.
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Any Questions?????
Laura Bryant 28th November 2016