विवरण
Non-invasive ventilation refers to the administration of ventilatory support without using an invasive artificial airway. It has been used as a replacement for invasive ventilation, and its flexibility also allows it to be a valuable complement in patient management.
Join us in this interactive discussion with Dr Hazem Lashin Consultant in Critical Care Medicine at NHS, who will be discussing the significant role of Non-Invasive Ventilation and its uses with a deep dive understanding.
सारांश
- Non-invasive ventilation (NIV) delivers ventilatory support via a machine and a tight-fitting face mask, avoiding the need for an endotracheal tube. In the UK, NIV typically refers to bi-level positive airway pressure (BiPAP).
- NIV works by using an interface to deliver insufflated gas to the patient's lungs. Flow sensors detect breath initiation and exhalation, while a valve allows expired gas to exit the circuit. The system connects to an NIV machine or conventional ventilator.
- NIV can be delivered through various interfaces, including full face masks, nose and mouth masks, easy masks, and hoods. Full face masks are the suggested option according to the guidelines. Choosing an interface depending on the indication and individual patient needs.
- During inspiration, NIV delivers inspiratory positive airway pressure (IPAP) to inflate the lungs. During exhalation, expiratory positive airway pressure (EPAP) maintains airway patency and facilitates gas exchange. IPAP is the equivalent of pressure support, and it differs from mechanical ventilation.
- NIV is primarily used for acute hypercapnic respiratory failure, stemming from the respiratory system's inability to maintain adequate alveolar ventilation and normal arterial PCO2. It is used for COPD, obesity-related respiratory failure, and acute cardiogenic pulmonary edema.
- CPAP differs from NIV by delivering a constant positive airway pressure throughout inspiration and expiration, primarily to improve oxygenation. CPAP can worsen CO2 retention in susceptible patients.
- In managing a patient with acute exacerbation of COPD, initial steps include controlled oxygen therapy (88-92% saturation), nebulized beta-agonists and anticholinergics, and systemic steroids.
- NIV is typically initiated with an EPAP of 3 cm H2O and an IPAP of 15 cm H2O, adjusting the oxygen fraction to maintain target saturation. Monitor blood gases and titrate IPAP to achieve near-normal PCO2.
- When NIV fails, consider factors such as comorbidities, exercise capacity, and reversibility of the underlying condition before deciding to intubate a patient with COPD. Patient wishes are also important.
- For a patient with community-acquired pneumonia (CAP) and hypercapnic respiratory failure, intubation may be preferable to NIV, especially if the patient shows signs of tiring or declining mental status.
- In post-operative patients with respiratory failure, pain management is crucial. Consider NIV, especially in ICU settings with close monitoring, but be prepared to intubate if necessary.
- British Thoracic Society (BTS) guidelines recommend NIV for acute hypercapnic respiratory failure due to conditions like COPD, neuromuscular disease, and obesity hypoventilation.
- Contraindications for NIV include acute asthma, pneumonia and severe acidosis (pH < 7.15 or < 7.25 with adverse features). Agitation and cognitive impairment are relative contraindications.
- BTS guidelines recommend a full face mask. The suggested setting for IPAP is 15 with EPAP 3.
- NIV should be considered in the ICU, where it is used for a wide variety of patients with close monitoring.
नमूना प्रमाण पत्र
वक्ताओं के बारे में
Dr Hazem Lashin
FRCP FFICM FHEA PhD Consultant in Critical Care Medicine Faculty Tutor in Intensive Care Medicine Clinical Lead for High Dependency Unit Barts Heart Centre, St Bartholomew’s Hospital West Smithfield, London, EC1A 7BE
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