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Part I: Noninvasive Positive Pressure Ventilation in the Acute Care Facility

Part I: Noninvasive Positive Pressure Ventilation in the Acute Care Facility. By: Susan P. Pilbeam, MS, RRT, FAARC John D. Hiser, MEd, RRT, FAARC Ray Ritz, BS, RRT, FAARC American Association for Respiratory Care December, 2006. Objectives.

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Part I: Noninvasive Positive Pressure Ventilation in the Acute Care Facility

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  1. Part I: Noninvasive Positive Pressure Ventilation in the Acute Care Facility By: Susan P. Pilbeam, MS, RRT, FAARC John D. Hiser, MEd, RRT, FAARC Ray Ritz, BS, RRT, FAARC American Association for Respiratory Care December, 2006

  2. Objectives • Define noninvasive positive pressure ventilation (NPPV) • Explain the benefits and complications of NPPV • Identify patients who are selected for or excluded from the use of NPPV • Describe the operating characteristics of NPPV devices that may be used for CPAP, bi-level non-emergent NIV and emergent NIV • Describe the selection, fitting and application of the patient interface

  3. Objectives (continued) • Compare advantages and disadvantages of the different interfaces used with NPPV • Explain the need for and application of humidification during NPPV • List the key components of patient assessment used to monitor NIV effectiveness • Discuss the steps in the initiation and management of NPPV • Recognize complications of NPPV and recommend ways to correct these problems • Describe weaning from NPPV

  4. Types of Noninvasive Ventilation (NIV) • Negative Pressure Ventilation (NPV) • Continuous Positive Airway Pressure (CPAP) • Noninvasive Positive Pressure Ventilation (NPPV)

  5. Negative Pressure Ventilation (NPV) • Negative pressure ventilators apply a negative pressure intermittently around the patient’s body or chest wall • The patient’s head (upper airway) is exposed to room air • An example of an NPV is the iron lung or tank ventilator

  6. Function of Negative Pressure Ventilators • Negative pressure is applied intermittently to the thoracic area resulting in a pressure drop around the thorax • This negative pressure is transmitted to the pleural space and alveoli creating a pressure gradient between the inside of the lungs and the mouth • As a result gas flows into the lungs

  7. Continuous Positive Airway Pressure - CPAP • Another form of noninvasive support is CPAP that is usually applied through a mask-type device • CPAP does not actually provide volume change nor does it support a patient’s minute ventilation • However, it is often grouped together in discussions about noninvasive ventilation

  8. CPAP • CPAP is most often used for two different clinical situations • First, CPAP is a common therapeutic technique for treating patients with obstructive sleep apnea • Second, CPAP is used in the acute care facility to help improve oxygenation, for example in patients with acute congestive heart failure (more on this later)

  9. Infant Nasal CPAP • Nasal CPAP in infants appears to help reduce several types of respiratory distress that occur in infants • Example, apneic episodes • Another example, delivery by Caesarean section (no vaginal “squeeze”) • Relief of severe hypoxemia in premature infants … along with surfactant replacement

  10. Noninvasive Positive Pressure Ventilation • NPPV provides positive pressure through the upper airway by some type of mask or other noninvasive interface (See Part II - Section on Interface Devices) • With NPPV, pressure is applied intermittently with inspiration having a higher pressure than expiration

  11. Noninvasive Positive Pressure Ventilation • NPPV is used to treat both acute and chronic respiratory failure • In the acute care setting NPPV can be used to treat patients with acute respiratory failure (ARF), such as acute exacerbation of COPD • In the patient with chronic respiratory failure, NPPV can be used to provide 24-hour ventilatory support

  12. NPPV in the Chronic Care Setting • Neuromuscular Diseases • Restrictive Thoracic Disorders • Chronic Stable COPD • Cystic Fibrosis • Nocturnal Hypoventilation • All patients requiring long term support are candidates for NPPV

  13. Noninvasive Ventilation in the Acute Care Setting • This module will focus on NPPV and CPAP in the acute care setting, beginning with NPPV • It will include noninvasive positive pressure ventilation (NPPV) in patients with acute respiratory failure (ARF). • Other indications for NPPV: • Do Not Intubate Patients • Facilitation of Weaning from Invasive ventilation • And CPAP in specific types of patients with ARF, i.e. those with acute congestive heart failure (WITHOUT myocardial infarction)

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