Ventilação não invasiva-VNI Flashcards
Prática
____non-invasive means of delivering positive pressure ventilation and ventilatory assistance to a spontaneously breathing patient. The objective is to deliver adequate ventilation support without intubation.
NON-INVASIVE POSITIVE PRESSURE VENTILATION (NIPPV) - BiPAP
also referred to as bi-level, bi-phasic, BiPAP or Vpap ventilation depending on literature and the manufacturer.
NIPPV
The patient breathes in one set pressure and out against another. It is a combination of:
IPAP : Inspired Positive Airway Pressure, and
EPAP: Expired Positive Airway Pressure.
BiPAP
- Increases tidal volume
- Reduces hypercapnia
- Reduces the work of breathing
IPAP (Otherwise known as Pressure Support)
- Increases lung volume
- Improves oxygenation
- Maintains an open airway
- Reduces the work of breathing
EPAP (Otherwise known as CPAP or PEEP)
not used on patients with an ETT tube insitu. Pressure support would be the most appropriate mode of choice.
NIPPV
- Adequate non-invasive ventilatory support for hypercapnic respiratory failure (thereby avoiding endotracheal intubation with all its complications)
- Symptomatic relief of dyspnoea
- Improvement of cardiac function in the presence of ischaemia and/or left ventricular afterload sensitivity
AIMS
Hypoventilation/Hypercapnic respiratory acidosis/Hypoxaemia Severe dyspnoea/Tachypnea
Patients with ventilatory muscle dysfunction (neuromuscular/cystic fibrosis)
Acute respiratory failure
Pulmonary contusion and flail chest Asthma
Chronic airway disease
Post-operative atelectasis
Obstructive sleep apnea/Cor Pulmonale Cardiogenic Pulmonary Oedema
Post extubation Support
Patient’s who are ‘Not for Intubation’
Indications
- Intubation is avoided.
- Increases functional residual capacity.
- Decreases work of breathing.
- Improves alveolar recruitment.
- Patient does not necessarily need an ICU bed. • Non-invasive – lower risk of infection.
- Mortality rates are lower.
- Intermittent ventilation
- Patient can eat, drink and communicate
- Ease of application and removal
- Patient can cooperate with physiotherapy
- Improved patient comfort
- Reduced sedation requirements
- Avoidance of complications of intubation
ADVANTAGES
- Patient’s inability to maintain his or her own airway. • Unstable facial fractures
- Excessive facial lacerations
- Laryngeal trauma
- Recent tracheal or oesophageal anastomosis
- Basal skull fracture
- Patient with recent GI surgeryor at risk of GIT bleeds/ileus
- Excessive secretions.
- Vomiting/ and or high aspiration risk
- Uncooperative or unmotivated patients.
- Cardiac or respiratory arrest
- Severe encephalopathy
- Coma
CONTRA-INDICATIONS
• Barotrauma • Haemodynamic compromise/ Decreased cardiac output/Hypotension • Aspiration • Pneumothorax • Gastric distention • High level of anxiety • Skin breakdown / pressure areas • Facial/eye oedema • Drying of mucous membranes (although this is limited through humidification/oral hygiene)
COMPLICATIONS
CAUSES
Excessive pressure Skin reaction
INTERVENTIONS
Provide pressure relief Change type of mask Clean mask
Signs & Symptoms
Skin discomfort
Air swallowing
Poor fitting mask Excessive air pressure Eating and drinking prior to commencement
Delay starting BiPaP for 2/3 hours
Nil by mouth
Administer antiemetics Adjust mask
Consider NG insertion
Gastric distension, Abdominal pain Regurgitation Aspiration
Over ventilation causing respiratory alkalosis
Discontinue use and reassess
Cramps, pins and needles sensations, light headedness
Anxiety
Reassure
Difficulty resting
Inadequate ventilation Discomfort with mask
Adjust setting Reassure Minor sedation
Claustrophobia
Drying effect of air flow
Add humidification Frequent eye and mouth care
Dryness, congestion
Possible pneumothorax
Discontinue immediately and prepare for emergency interventions – ie CXR and insertion of intercostal catheter
Chest pain, dyspnoea Low breath sounds (unilateral)
• A complete history and physical examination.
• Monitor heart rate, skin colour, peripheral perfusion, use of accessory
muscles, movement of chest wall.
• SpO2, CXR, ABG’s.
• Nil by mouth.
Before you initiate NIPPV you should do:
• Sizing of the mask is crucial. Select the smallest size to fit comfortably.
• The mask should fit from the end of the nasal bone to below the mouth and
resting on the chin.
• Skin protection is required especially with full face mask, on the bridge of thenose and on the forehead.
• Patients with dentures, sometimes it is hard to achieve a good seal. Keeping
the dentures in can help.
MASK SELECTION
Used to assist or replace spontaneous breathing
mechanical ventilation
primary indication for initiation of mechanical ventilation is____
respiratory failure, of which there are two basic types:
1.hypoxemic: arterial O2 saturation (SaO2) <90% occurs despite an increased inspired O2 fraction and usually results from v-perfusion mismatch or shunt
2.hypercarbic, >50 mmHg PCO2
when respiratory failure is chronic….
neither of the two types is obligatorily treated with mechanical ventilation, but when it is acute, mechanical ventilation may be lifesaving
acute respiratory failure with hypoxemia
- acute respiratory distress syndrome
- heart failure with pulmonary edema
- pneumonia
- sepsis
- complications of surgery and trauma
indications
