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Understanding Non-Invasive Ventilation Techniques

Mar 22, 2025

Non-Invasive Positive Pressure Ventilation

Overview

  • Non-invasive ventilation provides positive pressure ventilation without the use of an artificial airway.
  • Primary goal: Avoid intubation and reduce complications associated with mechanical ventilation.
  • Two main types: BiPAP and CPAP.

Non-Invasive Ventilation Settings

Key Settings

  • IPAP (Inspiratory Positive Airway Pressure): Pressure above zero during inspiration, similar to peak airway pressure in traditional ventilation.
  • EPAP (Expiratory Positive Airway Pressure): Pressure above zero during expiration, similar to PEEP in traditional ventilation.

Adjustments

  • Adjust IPAP and EPAP based on patient's ventilatory and oxygenation status.

Indications

  • Severe dyspnea, acute respiratory failure, COPD exacerbation, heart failure, pulmonary edema, DNR to avoid reintubation, obstructive sleep apnea.
  • Not for unstable or critically ill patients.

CPAP (Continuous Positive Airway Pressure)

Characteristics

  • Delivers and maintains positive pressure throughout the entire breathing cycle.
  • Only for spontaneously breathing patients; no mechanical breaths included.
  • IPAP = EPAP: Continuous pressure.

Primary Indication

  • Obstructive Sleep Apnea (OSA).

Contraindications

  • Apnea, hypoventilation, respiratory muscle fatigue, facial trauma, claustrophobia.

Monitoring

  • Watch for signs of fatigue: dyspnea, tachycardia, increased PaCO2, increased respiratory rate, decreased tidal volume.

BiPAP (Bi-level Positive Airway Pressure)

Characteristics

  • Two pressure levels: IPAP (controls tidal volume) and EPAP (functions as PEEP).

Indications

  • Acute respiratory failure, COPD exacerbation, cardiogenic pulmonary edema.

Contraindications

  • Similar to CPAP: apnea, unmanageable secretions, facial burns, claustrophobia.

Interfaces for BiPAP and CPAP

Types of Masks

  • Nasal Mask: Covers nose; common for sleep apnea; may leak for mouth breathers.
  • Oral-Nasal Mask: Covers mouth and nose; better seal, potential aspiration issues.
  • Nasal Pillows: Small prongs in nose; comfortable but not for BiPAP.
  • Full Face Mask: Covers entire face; largest, prevents leakage.

Titrating Non-Invasive Positive Pressure Ventilation

Adjustments

  • Starting point: IPAP 10 over EPAP 5 (10/5 cm H2O).
  • Adjust IPAP (8-12 cm H2O) and EPAP (4-5 cm H2O) based on needs.
    • Increase IPAP for larger tidal volume (decrease PaCO2).
    • Increase EPAP to improve oxygenation (increase PEEP).

Conclusion

  • Understanding BiPAP and CPAP helps in selecting appropriate therapy based on patient needs.
  • For further information, visit the provided resources and website.

Note: Always ensure the patient is monitored carefully when using non-invasive ventilation to adjust therapy as needed.

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