Noninvasive Positive Pressure Ventilation (NIPPV)

Expiratory ...
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Description

Noninvasive Positive Pressure Ventilation (NIPPV)



Expiratory & Inspiratory Positive Airway Pressure

Both increase intrathoracic pressure, which can decrease venous return.

Both can decrease LV afterload by reducing LV transmural pressure, potentially improving SV.

EPAP prevents upper & lower airway collapse and can "recruit" alveoli'.

IPAP can help generate larger VT and decreases respiratory fatigue, especially in obstructive lung and neuromuscular disease.

CPAP - Continuous Positive Airway Pressure - Provides EPAP. In CHF, decreases intubation and mortality

BPAP - Bi-Level Positive Airway Pressure - Provides both EPAP and IPAP. In COPD, decreases intubation, mortality, LOS

NIPPV Indications:

 • CHF exacerbation (cardiogenic pulmonary edema)

 • COPD exacerbation (often w/ acute on chronic resp acidosis)

 • Post-extubation in high risk patients (ie., CHF or COPD)

 • Other acute respiratory failure (ie.. asthma exacerbation)

 • Chronic respiratory failure (ie OHS and neuromuscular dz)

 • Pt is DNI with indication for intubation

 • Palliation for increased WOB, dyspnea

NIPPV Contraindications:

 • Risk of Aspiration - unable to clear secretions, altered mental status

 • Won't Work - Cannot initiate breath, Anatomic deformity (facial trauma, surgery, excess facial hair)

 • Risk Of Clinical Worsening - Cannot tolerate decreased preload, Recent intrathoracic damage (pneumothorax. esophageal injury, intrathoracic procedure/surgery)



Dr. Meredith Greer @EmmGeezee



#Noninvasive #PositivePressure #Ventilation #NIPPV #CPAP #BPAP #indications #criticalcare #management
Contributed by

Dr. Gerald Diaz
@GeraldMD
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief 🇵🇭 🇺🇸 - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG:  https://www.instagram.com/grepmed/ | Twitter: https://twitter.com/grepmeded/
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