Non Invasive Ventilation in copd Sarah Davey Specialist Registrar Emergency Medicine. Pinderfields General Hospital. Introduction NIV is the provision of ventilatory support through the patient’s upper airway using a mask or similar device.
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Specialist Registrar Emergency Medicine.
Pinderfields General Hospital.
- Pressure set during inspiration.
- Cm of H2O above atmospheric.
- Increases Tidal volume, reduces
work of breathing and increases
alveolar ventilation, reducing pCO2.
* usually set at 10-14 cmH2O and gradually increased as tolerated to a max. 20 cmH2O.
- Pressure set during expiration.
- Recruits under ventilated lung.
- Offsets intrinsic PEEP, aids triggering.
- Reduces perceived effort.
- Serves to vent exhaled gas thru the exhaust
port and reduce rebreathing.
* Set at 4-5 cmH2O.
- Back-up breath rate.
- Machine will automatically deliver
a breath to the patient if the resp.
rate falls below the set value.
- Usually set to 12-14 if available.
- Controls the rate of pressure change
during transition from EPAP to IPAP
phase of ventilation.
- i.e. Time taken to reach IPAP pressure.
- Intended for patient comfort.
- If respiratory rate is high then a faster
rise time is required.
- Co-existing pneumonia.
- Copious resp. secretions.
- Poor nutritional state.
- adjust O2 to maintain sats of 85-90%.
- check mask fit.
- check exhaust valve.
- consider increasing EPAP.
- observe patient.
- consider inc. EPAP or adjust rate.
- increase IPAP.
- Consider increasing inspiratory time.