Teachable Moments - Respiratory

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Non Invasive Ventilation

1. * Multiple studies support the use of noninvasive positive pressure ventilation (NPPV) in acute exacerbations of COPD, acute cardiogenic pulmonary edema, and immunocompromised patients (organ transplant) with hypoxic respiratory failure.
   * The timing of NPPV initiation is important. NPPV should be started as soon as possible, as delays increase the likelihood of intubation
   * The best predictor of success is a favorable response to NPPV within the first 1 to 2 hours
   o reduction in respiratory rate
   o improvement in pH
   o improved oxygenation
   o reduction in PaCO2
   * Also crucial to NPPV success is a well fitting interface (mask)
   * Although patients report greater comfort with nasal masks, they also permit more air leakage through the mouth and have been associated with a higher rate of initial intolerance in the acute setting.
   * For acute applications of NPPV in the ED, a full face mask is preferred
   
   References
   Garpestad E, Brennan J, Hill NS. Noninvasive ventilation for critical care. Chest 2007;132:711-20.