Non-invasive Ventilation

Question 1

What is non-invasive intubation?

Answer 1

• Alternative to full ventilation
• Use full face mask or tight fitted nasal mask to blow air forcefully into the lungs and ventilate them without need for intubation

Question 2

Why and when is non-invasive intubation used?

Answer 2

• Obstructive lung disease
• Less invasive than full intubation and ventilation
• don’t need anaesthetic and don’t need to insert tube into trachea

Question 3

What are the types of non-invasive intubation?

Answer 3

BiPAP - bilevel positive airway pressure

CPAP - continuous positive airway pressure

Question 4

How does CPAP work?

Answer 4

Continuous air blown into lungs which keeps the airway expanded so air can more easily travel in and out

Question 5

Where is CPAP indicated?

Answer 5

• Obstructive sleep apnoea
• Congestive cardiac failure
• Acute pulmonary oedema

Question 6

How does BiPAP work?

Answer 6

• Cycle of high and low pressure created during, higher in inspiration and Lower in expiration
• IPAP (inspiratory positive airway pressure)
• EPAP (expiratory positive airway pressure)

Question 7

When is BiPAP used?

Answer 7

• Type 2 respiratory failure usually due to COPD

- Started if respiratory acidosis is below 7.35 despite adequate medical control

Question 8

When is BiPAP contraindicated?

Answer 8

• untreated pneumothorax

- any structural or pathological abnormalities affecting face, airway or GI tract

Question 9

What investigations should be carried out prior to BiPAP?

Answer 9

CXR to exclude pneumothorax

Question 10

If BiPAP fails what is the next treatment step?

Answer 10

• Intubation and ventilation

- can also be more appropriate to initiate palliative care