[Music] welcome to ge healthcare's introduction to non-invasive ventilatory support in the icu i'm lisa nolan each day when a patient with acute respiratory failure copd or cardiogenic pulmonary edema arrives in the emergency room a physician needs to decide the best ventilatory support for the patient which is dependent on the severity of their disease for some it might include intubation but for others non-invasive ventilatory support may be the answer non-invasive ventilatory support includes non-invasive ventilation continuous positive pressure ventilation or cpap or high flow nasal cannula using the correct non-invasive ventilatory support on a patient may help to reduce the need for intubation or even reintubation following extubation the carescape rh-60 offers non-invasive vellutory support modes for your spontaneously breathing patient today we will discuss non-invasive ventilation mode or niv let's get started non-invasive ventilation mode or niv is a ventilation option on the carescape r860 which provides positive pressure ventilation to the spontaneously breathing patient it is delivered using an accessory like a nasal or full face mask which is attached to the patient's head to increase the quality of the airway seal to minimize leaks it is important to note that non-invasive ventilation mass should be non-vented and must not include an entrainment valve and the patient circuit should be a dual limb with connections for both the inspiratory and expiratory ports of the ventilator before using niv mode the patient should be able to demonstrate all of the following characteristics is responsive able to breathe spontaneously has a controlled airway requires pressure support ventilation when using niv mode the ventilator provides a set peep and pressure support level to a patient breathing spontaneously additional settings such as pressure support time inspiratory and expiratory triggers bias flow and rise time can be set to help with patient synchrony because flow triggers are affected by patient circuit leaks flow and pressure triggers are applied simultaneously in niv mode when a flow trigger is set by the user the ventilator uses a simultaneous pressure trigger to improve trigger detection for patient safety a maximum pressure backup inspiratory pressure a minimum rate and a backup inspiratory time should be set if the patient does not meet the set minimum rate for spontaneous breasts the ventilator delivers a backup breath based on the backup inspiratory time and backup inspiratory pressure settings if the ventilator does not detect any spontaneous breaths within a set patient effort time then a high priority alarm indicates that the patient has stopped triggering breaths the ventilator will continue to switch back and forth between pressure control and pressure support breaths based on the patient's spontaneous breathing efforts and set minimum rate once the patient exceeds the minimum rate the ventilator will remain in pressure support mode the low expired minute ventilation apnea time and leak alarm limits may be disabled to prevent nuisance alarms when large patient circuit leaks are present a medium priority alarm is active when any of the alarms are disabled selecting audio pause will acknowledge and de-escalate the alarm it is important to note that if you disable the apnea time leak alarm limits or low expired minute ventilation alarms it is recommended that additional monitoring such as pulse oximetry ecg and end tidal co2 should be used to protect the patient from hypoventilating using non-invasive ventilation mode with your spontaneously breathing patient is as easy as that on the carescape r860 i'm lisa nolan with ge healthcare thank you for joining our discussion on non-invasive military support in the icu