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NON-INVASIVE MV. Good news It works !!!!!!!. Warnings Not always Not for all Know the technique Be skilled. i-PSV and n-PSV delivered before and after extubation in patients not weaned. Arterial Blood Gases. pH PaCO 2 PaO 2 /FIO 2. i-PSV 7.38 59.1 206. n-PSV 7.38 61 210.

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slide1

NON-INVASIVE MV

Good news

  • It works !!!!!!!

Warnings

  • Not always
  • Not for all
  • Know the technique
  • Be skilled
slide2

i-PSV and n-PSV delivered before and

after extubation in patients not weaned

Arterial Blood Gases

pH

PaCO2

PaO2/FIO2

i-PSV

7.38

59.1

206

n-PSV

7.38

61

210

T-tube

7.33

69

183

(from Vitacca M. et al. AJRCCM 2001; 164: 638-641)

slide3

NON-INVASIVE MV

  • NIV in the “real-world”
  • Setting the ventilator
  • Choice of interfaces
  • Humidification and drug delivery
slide4

NON-INVASIVE MV

  • NIV in the “real-world”
  • Setting the ventilator
  • Choice of interfaces
  • Humidification and drug delivery
slide5

The Use of Noninvasive Ventilation in

Acute Respiratory Failure at a Tertiary

Care Center*

Elizabeth S. Paus-Jenssen, MD; John K. Reid, MD;

Donald W. Cockcroft, MD, FCCP; Karen Laframboise, MD;

and Heather A. Ward, MD, FCCP

Chest 2004; 126: 165-72

slide7

60% Hypercapnic

55% Hypoxic

slide8

NON-INVASIVE MV

  • NIV in the “real-world”
  • Setting the ventilator
  • Choice of interfaces
  • Humidification and drug delivery
slide10

Appropiate setting for long-term NPSV (n=23 hypercapnic COPD patients)

Change (% of SB)

(from Vitacca M. et al. Chest 2000)

slide11

Assessment of Physiologic Variables

and Subjective Comfort Under Different

Levels of Pressure Support Ventilation*

Michele Vitacca, MD; Luca Bianchi, MD; Ercole Zanotti, MD;

Andrea Vianello, MD; Luca Barbano, MD; Roberto Porta, MD; and

Enrico Clini, MD, FCCP†

Chest 2004; 126: 851-59

slide12

V’E, PTP

Study protocol

SB (baseline)

V’E, PTP

Pao, IE

RANDOM of ventilators

comfort

0

setting

10

Time (min)

slide15

NON-INVASIVE MV

  • NIV in the “real-world”
  • Setting the ventilator
  • Choice of interfaces
  • Humidification and drug delivery
slide20

Side effects due to NPPVN=26 (compliant patients)

%

Mask leaks

Skin irritation

Rhinitis / aerophagia

Discomfort

43

23

13

8

(from Criner GJ. et al. Chest 1999;116:667-675)

slide22

MOUTH LEAKS IN NASAL NPPV(n=9, hypercapnic=7, COPD=6, age 64 years)

PtcCO2 (mmHg)

Arousal Index (events h-1)

p<0.001

p<0.0002

(from Teschler H. et al. ERJ 1999; 14: 1251-1257)

slide25

Side effects due to NPPVN=26 (compliant patients)

%

Mask leaks

Skin irritation

Rhinitis / aerophagia

Discomfort

43

23

13

8

(from Criner GJ. et al. Chest 1999;116:667-675)

slide30

Esperienza dell’équipe

Considerazioni anatomiche

CRITERI PER LA SCELTA DELLA MASCHERA

Compliance e sensorio del paziente

Modalità di ventilazione

slide32

NON-INVASIVE MV

  • NIV in the “real-world”
  • Setting the ventilator
  • Choice of interfaces
  • Humidification and drug delivery
slide34

In the present pilot study, the use heated humidification and heat and moisture exchanger showed similar tolerance and side-effects, but a higher number of patients decided to continue long-term noninvasive mechanical ventilation with heated humidification.

slide37

To conclude, when using noninvasive positive pressure ventilation with two-level respirators, oxygen should be added close to the exhaust port (ventilator side) of the circuit. If inspiratory airway pressure levels are >12 cmH2O, oxygen flows should be at least 4 L*min-1

slide38

Respir Care 2004;49(3):270–275.

CONCLUSIONS

Delivered oxygen concentration during BiPAP is a complex interaction between the leak port type, the site of oxygen injection, the ventilator settings, and the oxygen flow.

Because of this, it is important to continuously measure arterial oxygen saturation via pulse oximetry

with patients in acute respiratory failure who are receiving noninvasive ventilation from a bi-level ventilator.

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