Non Invasive Ventilation

What is it?
What is it?

Respiratory support given

without an endotracheal tube

Spontaneously breathing
patients
Normal Breathing
o negative pressure

o air is drawn in when

the diaphragm
descends
3 types:

IPPB Intermittent Positive Pressure Breathing

CPAP Continuous Positive Airways Pressure

BiPAP Bi-level Positive Airways Pressure

CPAP
High flow oxygen + PEEP
o Wispaflow
o Dräger
Raises FRC away from residual volume
Splints alveoli open: ↓ work of breathing
↑ PaO2
re-expand atelectasis
Helps resolution of pulmonary oedema
Lung Capacities
Maximal inspiration

TV
Resting expiratory level
FRC

RV Maximal expiration
Closing Volume and Functional
Residual Capacity

FRC
Increased CV

CV

Decreased FRC

FRC – Functional Residual Capacity

CV – Closing Volume
BiPAP

IPAP + EPAP

EPAP = PEEP

Inspiratory pressure increases tidal

volume
ο ↓ PaCO2
ο ↑ PaO2
ο ↓ work of breathing and fatigue
Terminology
16

12 IPAP

Pressure Support
8

4 EPAP

0
CPAP or BiPAP?
Respiratory Failure

Type I low PaO2 < 8 kPa

all else normal

Type II low PaO2

high PaCO2
ABGs
Normal Values

pH 7.35 - 7.45
PaO2 10.7 - 13.3 kPa
PaCO2 5.6 - 6.7 kPa
HCO3- 22 - 26 mmol
BE 2 - +2
-
Type I Failure Type II Failure

Hypoxia Hypercapnia
Hypoxia

CPAP BiPAP
group work
Clinical benefits
Acute Chronic
o Type I respiratory o Sleep apnoea
failure o Type II respiratory
o Type II respiratory failure
failure  COPD
o Pulmonary oedema  CF
 Neuromuscular
Sub-acute diease
o Weaning
o Post-extubation
Precautions
o Impaired consciousness
o Confusion/agitation
o CXR showing consolidation
o Drained pneumothorax
o Copious secretions
o Inability to protect airway
o Haemodynamic instability
o Recent upper GI surgery or bowel
obstruction
Contraindications

o Need for immediate intubation

o Facial trauma/burns
o Frequent vomiting
o Recent facial/upper airway surgery
o Undrained pneumothorax
Advantages of avoiding intubation

No paralysis or sedation
o Ability to move – pressure relief
o Able to communicate
o Able to eat and drink
o Self care
o Less need for invasive monitoring
o Less risk of infection
No endotracheal tube
ο ↓ infection risk
o No tracheal damage
o Able to communicate

Decreased need for ITU

o Cost
o Patient and carer experience
o Less debilitating
Implications for Physiotherapy

o Mask fitting
o Deoxygenation
o Expectoration
o Familiarity with machines/alarms
Skills needed

o Patient handling/communication
o Knowledge of respiratory physiology
o Familiarity with interfaces
o Knowledge of pressure area care
o Time to spend with patient
o Patience
Beware!
o ‘CPAP’ mode on ITU ventilators

Spontaneous breathing mode

IP + PEEP