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
• 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
• 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
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