21 Nasal Mask Advantages Disadvantages Less risk of aspiration Easier secretion clearanceLess claustrophobiaEasier speechMay allow patient to eatEasy to fit and secureLess dead spaceDisadvantagesMouth leakHigher resistance through nasal passageLess effective with nasal obstructionNasal irritation and rhinorrheaMouth dryness
22 Oronasal Mask(full face) AdvantagesBetter control of mouth leakMore effective with mouth breathers , particularly during acute application of NIPPVDisadvantagesMore dead spaceClaustrophobiaMore risk of aspirationMore difficulty in eating and speakingAsphyxiation if ventilator malfunction
30 Initial Settings EPAP = CPAP IPAP = Pressure Support (Include PEEP or above PEEP)Back up RatePramp(Rising Time) OptionalFiO2
31 Pressure support ventilation(PS) The faster the initial rise to peak flow level,the sooner the set pressure limit is reachedSlow rise to set pressure level is more comfortable for the patientExessively fast rise to peak flow may cause the ventilator to overshoot the initial pressure limit and create a pressure spike,which can cause discomfort and increase WOB
35 Pressure support ventilation(PS) Typically used in the SIMV mode to facilitate weaning in a difficult to wean patientIncrease spontaneous Vt (set PS until a desired spontaneous Vt)Decrease spontaneous respiratory rate (set PS until a desired spontaneous RR)Decrease the work of breathing
36 Pressure support ventilation(PS) End flow(resp. cycle off)Rise time
41 True NIV Adjustable Baseflow Variable Cycle Threshold Variable Trigger PRESSURE Cm H2OEPAPIPAPVariable CycleThresholdThis slide to give our word definition to pass from IPAP to EPAP -> Cyclingand EPAP to IPAP -> TriggeringVariable TriggerThreshold
47 COPD Exacerbation (7.30≤pH<7.35) Interface and type of circuitnasal maskSingle limb with leakage valveInitial SettingsEPAP 4-8 cmH2OIPAP 8-10 (above EPAP 4-6) cmH2O titrate until VtBack up rate 8-10/minFiO2 keep SpO2 >92%
48 Severe COPD Exacerbation(pH< 7.30) Interface and type of circuitOro-nasal maskSingle limb with leakage valveInitial SettingsEPAP 4-8 cmH2OIPAP 8-10 (above EPAP 4-6) cmH2O titrate until VtBack up rate 8-10/minFiO2 keep SpO2 >92%Close monitoring
49 Cardiogenic Pulmonary edema Interface and type of circuitOro-nasal mask (High Flow system )Single limb with leakage valveInitial SettingsEPAP 4-8 cmH2O titrate until ≈ 8-10IPAP 8-10 (above EPAP 4-6) cmH2O titrate until Vt (OPTIONAL)Back up rate 8-10/minFiO2 keep SpO2 >92%(High FiO2)Close monitoring
50 Hypoxic Respiratory Failure Interface and type of circuitOro-nasal mask (High Flow system )Single limb with leakage valveInitial SettingsEPAP 4-8 cmH2OIPAP (above EPAP 8-20) cmH2O titrate until VtBack up rate /minFiO2 keep SpO2 >92%(High FiO2)Close monitoring
51 How to succeed in NIV Not too bad ventilator!! Good candidate Good initial settingsGood monitoringGood criteria for termination(change to invasive)Not too bad ventilator!!
52 Long-term Mechanical Ventilation Home Mechanical VentilationNon-invasive Ventilation(NIV)
Your consent to our cookies if you continue to use this website.