NIV What is it? How does it work? When does it work? What does the evidence suggest?
NIV Indications –Hypercapnic respiratory failure –COPD with resp acidosis pH 7.25-7.35 –Cardiogenic pulmonary oedema –Pneumonia in the immunosuppressed –Weaning from the ventilator in hypercapnic COPD patients
Cochrane NIV vs Medical therapy alone –Lower mortality NNT 8 –Prevent intubation NNT 5 –Length of stay –Improved pH/paCO2/RR within 1h of tx
NIV Compared with intubation.. –Hosp acq pneumonia –Complications
Mechanical Ventilation Indications for intubation –Airway –Ventilation –Improve Oxygenation –Decrease work of breathing –Stabilise chest wall in severe injury
Summary Resp failure is the inability to maintain adequate gas exchange Type 1: hypoxaemic Type 2: hypercapnic + hypoxaemic NIV should be considered in –patients with hypercapnic resp failure –cardiogenic pulmonary oedema –pneumonia in immunosuppressed