NIV oncall

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By: sxwwd (13 month(s) ago)

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By: homira (47 month(s) ago)

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Presentation Transcript

Non Invasive Ventilation: 

Non Invasive Ventilation What is it?

What is it?: 

What is it? Respiratory support given without an endotracheal tube Spontaneously breathing patients

Normal Breathing: 

Normal Breathing negative pressure air is drawn in when the diaphragm descends

3 types: : 

3 types: IPPB Intermittent Positive Pressure Breathing CPAP Continuous Positive Airways Pressure BiPAP Bi-level Positive Airways Pressure

CPAP: 

CPAP High flow oxygen + PEEP Wispaflow Dräger Raises FRC away from residual volume Splints alveoli open:  work of breathing  PaO2 re-expand atelectasis Helps resolution of pulmonary oedema

Lung Capacities: 

Lung Capacities Maximal inspiration Maximal expiration TV RV FRC Resting expiratory level

Closing Volume and Functional Residual Capacity: 

Closing Volume and Functional Residual Capacity Increased CV Decreased FRC FRC CV FRC – Functional Residual Capacity CV – Closing Volume

BiPAP: 

BiPAP IPAP + EPAP EPAP = PEEP Inspiratory pressure increases tidal volume  PaCO2  PaO2  work of breathing and fatigue

Terminology: 

Terminology IPAP EPAP Pressure Support 0 4 8 12 16

CPAP or BiPAP?: 

CPAP or BiPAP?

Respiratory Failure: 

Respiratory Failure Type I low PaO2 < 8 kPa all else normal Type II low PaO2 high PaCO2

ABGs: 

ABGs Normal Values pH 7.35 - 7.45 PaO2 10.7 - 13.3 kPa PaCO2 5.6 - 6.7 kPa HCO3- 22 - 26 mmol BE -2 - +2

Slide13: 

Type I Failure Hypoxia CPAP Type II Failure Hypercapnia Hypoxia BiPAP

Slide14: 

group work

Clinical benefits: 

Clinical benefits Acute Type I respiratory failure Type II respiratory failure Pulmonary oedema Sub-acute Weaning Post-extubation Chronic Sleep apnoea Type II respiratory failure COPD CF Neuromuscular diease

Precautions: 

Precautions Impaired consciousness Confusion/agitation CXR showing consolidation Drained pneumothorax Copious secretions Inability to protect airway Haemodynamic instability Recent upper GI surgery or bowel obstruction

Contraindications: 

Contraindications Need for immediate intubation Facial trauma/burns Frequent vomiting Recent facial/upper airway surgery Undrained pneumothorax

Advantages of avoiding intubation: 

Advantages of avoiding intubation No paralysis or sedation Ability to move – pressure relief Able to communicate Able to eat and drink Self care Less need for invasive monitoring Less risk of infection

Slide19: 

No endotracheal tube  infection risk No tracheal damage Able to communicate Decreased need for ITU Cost Patient and carer experience Less debilitating

Implications for Physiotherapy: 

Implications for Physiotherapy Mask fitting Deoxygenation Expectoration Familiarity with machines/alarms

Skills needed: 

Skills needed Patient handling/communication Knowledge of respiratory physiology Familiarity with interfaces Knowledge of pressure area care Time to spend with patient Patience

Beware!: 

Beware! ‘CPAP’ mode on ITU ventilators Spontaneous breathing mode IP + PEEP