Non-Invasive Ventilation (NIV) is a respiratory support therapy that delivers positive airway pressure without the need for invasive procedures like intubation. At SHIFAA PAN African Hospitals, our Respiratory Therapy and Critical Care teams specialize in providing NIV to manage various respiratory conditions, improve lung function, and enhance patient comfort and outcomes.

Overview of Non-Invasive Ventilation (NIV):

Indications for NIV:

• Acute Respiratory Failure: Including exacerbations of Chronic Obstructive Pulmonary Disease (COPD), congestive heart failure (CHF), pneumonia, and acute respiratory distress syndrome (ARDS).
• Chronic Respiratory Conditions: Such as obesity hypoventilation syndrome (OHS), neuromuscular disorders (e.g., ALS, muscular dystrophy), and sleep-related breathing disorders (e.g., obstructive sleep apnea).
• Post-Operative Support: After certain surgeries or during recovery phases where respiratory support is needed.

NIV Equipment and Modes:

NIV Devices:

• Bi-level Positive Airway Pressure (BiPAP) Machines: Deliver varying levels of pressure support during inhalation (IPAP) and exhalation (EPAP), aiding ventilation and improving gas exchange.
• Continuous Positive Airway Pressure (CPAP) Machines: Provide a constant pressure level throughout the respiratory cycle, primarily used for obstructive sleep apnea and certain respiratory conditions.

NIV Modes:

• Spontaneous/Timed (S/T) Mode: Allows patient-triggered breaths with set backup breaths per minute, suitable for stable patients requiring moderate support.
• Pressure Support (PS) Mode: Provides inspiratory pressure support above positive end-expiratory pressure (PEEP), aiding ventilation effort and enhancing oxygenation.
• Volume-Assured Pressure Support (VAPS): Maintains a target tidal volume, adjusting pressure support based on patient’s respiratory needs and volumes.

Key Points on NIV:

Benefits of NIV:

• Avoidance of Intubation: NIV reduces the need for invasive mechanical ventilation (endotracheal intubation), preserving airway integrity and reducing associated risks.
• Improved Patient Comfort: Patients can communicate, eat, and maintain oral hygiene while receiving respiratory support, enhancing overall comfort and compliance.
• Reduced Complications: Compared to invasive ventilation, NIV lowers risks of ventilator-associated pneumonia (VAP), airway injury, and sedation-related complications.

Patient Selection and Monitoring:

• Rigorous patient assessments, including respiratory status, blood gases, chest imaging, and underlying conditions, guide NIV initiation, settings, and monitoring parameters.
• Continuous monitoring of respiratory parameters, oxygen saturation, work of breathing, and clinical response ensures therapy effectiveness, patient safety, and timely interventions.

Post-NIV Care and Follow-up:

Transition and Weaning:

• Gradual weaning protocols based on clinical improvement, respiratory parameters, and patient tolerance guide the transition from NIV to lower support levels or spontaneous breathing.
• Close monitoring of respiratory status, blood gases, and follow-up assessments optimize weaning strategies, prevent complications, and promote successful outcomes.

FAQs:

What is Non-Invasive Ventilation (NIV), and when is it used?

NIV delivers positive airway pressure without intubation, used for acute respiratory failure, chronic respiratory conditions, and post-operative support, improving lung function and patient comfort.

 

How does NIV differ from Invasive Mechanical Ventilation?

NIV avoids airway intubation, using masks or interfaces to deliver pressure support, primarily for stable patients with respiratory distress or chronic conditions, reducing complications associated with invasive ventilation.

 

What are the benefits and limitations of NIV compared to Invasive Ventilation?

NIV offers improved patient comfort, reduced risks of airway injury and ventilator-associated complications; however, it may be limited in severe respiratory failure or patients unable to tolerate masks or interfaces.

 

What types of NIV devices and modes are available, and how are they chosen?

BiPAP and CPAP machines with modes like S/T, PS, and VAPS provide tailored pressure support based on patient needs, respiratory status, and therapeutic goals determined by healthcare providers.

 

How is NIV monitored during therapy, and what are signs of therapy effectiveness or failure?

Continuous monitoring of respiratory parameters, oxygenation, work of breathing, and clinical response assess NIV effectiveness. Signs of improvement include stable blood gases, reduced respiratory distress, and improved oxygen saturation.

 

What post-NIV care and follow-up are necessary for patients?

Post-NIV care involves weaning protocols, respiratory monitoring, follow-up assessments, and patient education on home management, mask care, and recognizing signs of worsening symptoms requiring medical attention.

 

Are there alternatives or adjuncts to NIV for respiratory support?

Depending on patient conditions, adjuncts like high-flow nasal cannula (HFNC) therapy, non-invasive positive pressure ventilation (NIPPV), or invasive ventilation may be considered, tailored to individual respiratory needs and response to therapy.