NON-INVASIVE VENTILATION

2/13/2016

The ambulance bring a patient in on a rebreather. She is elderly and has been unwell for the last few days.
Her respiratory rate is 32, heart rate is 125 and sats are 90%. She is afebrile and examination is normal apart for a few creeps in both bases.

A set of gases reveals the following:
pH 7.3
PaO2 63
PaCO2 37
HCO3 20
SaO2 90%
Does she meet Criteria for Non-Invasive Ventilation(NIV)? Yes she does?
What type of NIV would you use; CPAP or BiPAP?
What type of NIV would you use for:
(A) Acute Pulmonary Oedema?
(b) COPD?
(c) Asthma?
.... and why ... all answers in the 9 minute video below:
You place the patient on BiPAP (settings EPAP 6 / IPAP 11) and wean down to 50% and the patients gases improve markedly:
paO2 137
paCO2 39
The patients respiratory rate is still high at 28 breaths per minute.
What setting would you change on the machine to assist the patient?

4 Comments

Paul Davies

2/12/2016 11:54:52 am

Michael Ifesanwo

2/14/2016 03:23:24 pm

NIV made easy! Thanks Peter!!

Zafar Khan

5/14/2016 04:30:50 pm

JAMA. 2005 Dec 28;294(24):3124-30.
Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis.
Masip J1, Roque M, Sánchez B, Fernández R, Subirana M, Expósito JA.
Author information

Journal of Cardiac FailureVolume 17, Issue 10, October 2011, Pages 850–859 Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema: A Meta-Analysis of Randomized Controlled Trials

Listening to your video , you have mentioned that no difference in mortality between O2, CPAP and BiPAP in APO.

Both above studies have concluded that there is significant decrease in mortality when NIV was compared to standard therapy which was O2.

Regards

Zafar

Peter

5/15/2016 07:01:05 pm

Hi Zafar
Thanks for the comment. That was me being a little cheeky.
Show me a good randomised trial! Not many.
I also agree that NIV helps, that's why I made the video. I want to see randomised controlled trials reproduced and validated. Even the author you quoted states in his own paper; "The evidence of individual studies in acute cardiogenic pulmonary edema (ACPE) supporting noninvasive ventilation (NIV) is still inconclusive, particularly regarding noninvasive positive pressure ventilation (NIPPV)."
The studies that you mention are meta analysis with pooled results and 'adjusted indirect comparisons' whatever that means.

That's what I think I meant.
I'll keep using it, if it works for my patient, but you have to choose your patient.
Peter

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