• What is it Non-Invasive Ventilation(NIV)?

Non- Invasive Ventilation(NIV) refers to the administration of ventilatory support with Ventilators (Breathing Machines)without using an invasive artificial airway (Breathing Tube/Endotracheal Tube or Tracheostomy). NIV is usually delivered with a (CPAP) Mask that is attached to a circuit and the circuit(tubing) is attached to the ventilator. The main goal of NIV ventilation is to improve oxygenation and also to avoid Intubation.

The use of noninvasive ventilation has markedly increased over the past two decades, and noninvasive ventilation has now become an integral tool in the management of both acute and chronic respiratory failure, in both the home setting and in Intensive Care/ Critical Care. Noninvasive ventilation has been used as a replacement for invasive ventilation with Ventilators (Breathing Machines) but its flexibility also allows it to be a valuable complement in Patient management.

In order for your loved one to tolerate the NIV therapy, he or she has to be awake and he or she needs to have the ability to breath spontaneously. The main difference to breath with NIV is that when your loved one is breathing in(inspiration), positive pressure from the ventilator assists that breath and when breathing out(expiration) positive pressure also prevents the lungs from collapsing. With all this support, your loved one will find it easier to breath, even though the mask sits tight on your loved ones face. Modes of NIV ventilation are CPAP(Continuous Positive Airway Pressure) and BIPAP ventilation.

• Why is it done?
• What happens in Intensive Care?

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It can be used short term and long term. In an Intensive Care setting, NIV is more for short term use and is usually for those Patients who are having difficulties breathing. NIV is usually administered over a period of days.

Out of hospital use is usually for Patients with Obstructive sleep apnea(OSA)

Why is it done?

NIV is a way of supporting and facilitating a Patient’s breathing efforts when they are having breathing difficulties. It is used for certain conditions such as;

• Obstructive sleep apnoea
• Pneumonia and alveoli collapse
• Pulmonary oedema
• COPD
• after Extubation
• Acute Severe Asthma
• Immunocompromised state
• Postoperative respiratory distress and respiratory failure
• If a Patient is not for Intubation
• Neuromuscular respiratory failure
• Decompensated obstructive sleep apnea
• Cystic fibrosis(CF)
• in the early stages of Adult Respiratory Distress Syndrome (ARDS)

NIV ventilation improves your loved ones breathing by

•  Increasing the size of the breath on inspiration through delivery of positive pressure(Pressure support and PEEP)
• Decreasing the amount of work your loved one has to create to take that breath
• Preventing collapse of alveoli (tiny air filled sacks at the end of the lungs – this is where oxygen goes into the blood) and also opening collapsed alveoli through pressure, enabling more alveoli to exchange oxygen into the blood
• Delivery of high concentrations of Oxygen

What happens in Intensive Care?

In Intensive care NIV is used to support your loved ones breathing in the acute phase until their respiratory condition has either improved and does not require this therapy anymore. On the other hand, despite the NIV therapy, your loved one may  not improve or even deteriorate where invasive ventilation with Intubation of a Breathing Tube or Endotracheal Tube may have to be instigated. This procedure leads to your loved one being mechanically ventilated on Ventilators (Breathing Machines) that are doing all of the work.

The types of masks used to deliver NIV range from full face masks that cover the face and the head, to masks that only cover the nose and the mouth. Either mask is ‘tightened’ on to your loved ones face in order to have a proper seal for adequate and sufficient positive pressure delivery.

From the outside this looks very uncomfortable and it often is very uncomfortable for your loved one to begin with, however given time, your loved one can feel the improvement the NIV ventilation makes to their breathing.

References

Stoltzfus S, (2006) The role of non-invasive ventilation, CPAP and BiPAP in the treatment of congestic heart failure. Dimensions of Critical Care Nursing, 25(2), 66-70.

Kannan, S. (1999). Practical issues in non-invasive positive pressure ventilation. Care of the Critically Ill, 15 (3) 76-79.

Knebel, A., Allen, M., McNemar, A. & Feigenbaum, K. (1997). A guide to non-invasive intermittent ventilatory support. Heart & Lung, 26 (4) 307-316.

Mahamid, E. (2000). Non-invasive positive-pressure ventilation in acute respiratory failure. Care of the Critically Ill, 16 (2). 55-58.

Marshall, A. & Pittard, M. Nursing the patient receiving Continuous Positive Airway Pressure Therapy. Australian Nurses Journal, Clinical Update. February 1998.

Moore, M.J. & Schmidt, G.A. (2001). Keys to effective non-invasive ventilation, Part 1: Initial steps. Journal of Critical Illness, 16 (2) 64-70.

Any Questions?

Of course, if you have any questions or concerns, please discuss them with the ICU nurses and doctors.

All Intensive Care interventions and procedures carry a degree of potential risk even when performed by skilled and experienced staff. Please discuss these issues with the medical and nursing staff who are caring for your loved one.

The information contained on this page is general in nature and therefore cannot reflect individual Patient variation. It is meant as a back up to specific information which will be discussed with you by the Doctors and Nurses caring for your loved one. INTENSIVE CARE HOTLINE attests to the accuracy of the information contained here BUT takes no responsibility for how it may apply to an individual Patient. Please refer to the full disclaimer.