Non-Invasive Ventilation

Question 1

What is NIV?

Answer 1

Non-invasive ventilation is used as an alternative to full intubation and ventilation to support the lungs in respiratory failure due to obstructive lung disease

Question 2

What types of NIV are there?

Answer 2

CPAP

BiPAP

Question 3

What is BiPAP?

Answer 3

BiPAP stands for bilevel positive airway pressure. This involves a cycle of high and low pressure to correspond to the patients inspiration and expiration.

Question 4

When is BiPAP used?

Answer 4

BiPAP is used where there is type 2 respiratory failure, typically due to COPD.

Question 5

Criteria for initiating BiPAP

Answer 5

Respiratory acidosis (pH < 7.35, PaCO2 >6) despite adequate medical treatment.

Question 6

Main CI for BiPAP.

Answer 6

Untreated pneumothorax

Question 7

What is BiPAP divided into?

Answer 7

IPAP

EPAP

Question 8

What is IPAP and EPAP?

Answer 8

IPAP (inspiratory positive airway pressure) is the pressure during inspiration. This is where air is forced into the lungs.

EPAP (expiratory positive airway pressure) is the pressure during expiration. This provides some pressure during expiration so that the airways don’t collapse and it helps air to escape the lungs in patients with obstructive lung disease.

Question 9

How is a BiPAP weaned off?

Answer 9

Repeat an ABG 1 hour after every change and 4 hours after that until stable. The IPAP is increased by 2-5 cm increments until the acidosis resolves.

Question 10

What is CPAP?

Answer 10

CPAP stands for continuous positive airway pressure. It provides continuous air being blown into the lungs that keeps the airways expanded so that air can more easily travel in and out.

Question 11

When is CPAP used?

Answer 11

Used to maintain the patient’s airway in conditions where it is prone to collapse.

Indications for CPAP:

Obstructive sleep apnoea

Congestive cardiac failure

Acute pulmonary oedema