Non invasive ventilation (nippy)

Question 1

How does non invasive ventilation work (nippy)

Answer 1

It has positive pressure on insufflation and forced expiration negative pressure on exsufflation. Set to insufflation for atelectasis and insufflation and exsufflation for sputum clearance

Can be pressure or volume controlled

Question 2

Indications

Answer 2

Atelectasis
Sputum clearance
Poor inspiration WOB

Question 3

Contraindications

Answer 3

Undrained pneumothorax
Flail chest
Emphysemaptous bullae
Distended abdomen 
Active tb 
Haemoptysis 
Tumour

Question 4

What pressure should NIV be used at

Answer 4

At Least 20cmh20 for therapeutic benefit, aim for 30-40 for atelectasis treatment
Start at 15cmh20 and build up. Can give mild sedatives if stressed