NIV: What’s the big deal?
Type 1 RF requires CPAP type of NIV.
Type 2 RF requires BPAP type of NIV.
PEEP=EPAP=CPAP i.e. they all mean the same!
So you can say in Type 1 RF (Hypoxic failure), the pressure we provide is PEEP or just EPAP or CPAP.
For Type 2 RF (Hypercapnic), we provide IPAP as well as EPAP. IPAP is greater than EPAP, PS (Pressure Support is the difference between IPAP and EPAP). For instance if IPAP = 15 and EPAP is 10 then PS = 15-10 i.e. 5cm H2O.
Noninvasive ventilation decreased endotracheal intubation rates and hospital mortality in acute hypoxemia non-hypercapnic respiratory failure excluding chronic obstructive pulmonary disease exacerbation and cardiogenic pulmonary edema patients. There is no sufficient scientific evidence to recommend bi-level positive airway pressure or helmet due to the limited number of trials available. Large rigorous randomized trials are needed to answer these questions definitely.
How to set up Non-Invasive Ventilation (NIV)
Who Needs It?
- Patients with moderate to severe COPD exacerbations
- Those patients with cardiogenic pulmonary edema with increased work of breathing or hypercapnia
- Patients with isolated blunt thoracic trauma
- The immunocompromised patient with hypoxic respiratory failure
- Patients who require pre-oxygenation prior to intubation
Antibiotics for Acute Exacerbations of COPD
Principles of Mechanical Ventilation
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