Ventilator¶

NIV¶

CPAP - if you were to ride in a car and hang your head out the window at highway speeds, you would feel a rush of air into your mouth whenever you breathed in, and a resistance whenever you exhaled. This, in effect, is what continuous positive airway pressure (CPAP) is—a pressure applied to your respiratory system during both inhalation and exhalation. CPAP is applied during spontaneous respiration
BIPAP

Push O2 in hypoxia by Pressure and PEEP set from preventing lung collapse
CPAP works mainly by increasing intrathoracic pressure. It prevents airway and alveolar collapse.

General Use: NIV is now a standard treatment for acute respiratory failure (ARF), moving past initial safety concerns.
COPD: First-line treatment for severe exacerbations; significantly decreases the need for intubation and mortality.
Cardiogenic Pulmonary Edema: Highly effective, reducing intubation rates and mortality. CPAP and BIPAP are equally effective.
Hypoxemic Respiratory Failure: Shows mixed results; beneficial for pneumonia and post-operative respiratory failure but not for ARDS.
Severe Asthma: May reduce intubation rates, but recommendations remain controversial due to limited study data.
Obesity Hypoventilation Syndrome: As effective as for COPD in treating acute respiratory failure.
Outpatient: Also used to treat obstructive sleep apnea (OSA).

Absolute Contraindications:
- Apnea or respiratory arrest.
- Inability to protect the airway (e.g., vomiting, copious secretions, severe bleeding).
- Uncooperative or agitated patients.
- Significantly altered mental status (except for hypercapnic encephalopathy).
- Hemodynamic instability, shock, or multiple organ failure.

Apply supplemental oxygen (e.g., through a nasal cannula, face mask, or nonrebreather mask) until replaced by the NIV interface.
Set the ventilator to the correct settings and be ready to connect to the interface.
Select the mode and adjust the initial settings
Start with low pressure to help the patient tolerate and synchronize with the ventilator.
Consider starting with CPAP/PEEP of 3 to 5 mmHg and PSV of 3 to 5 mmHg if using BIPAP.
Start with an FIO2 of 50% to 60%.
Adjust the FIO2 after connecting the ventilator to keep the saturation within an acceptable range.
Never exceed a total pressure (i.e., PSV + PEEP) of 25 cmH2O because this may lead to gastric insufflation.
ABG every 2hrs for improvement status

Nasal bridge skin ulceration is a result of excessive pressure of strap , use cushions to prevent
Increased intrathoracic pressure can result in hypotension, hemodynamic compromise, and deterioration. Attempt to lower the pressure to resolve this.
Gastric distension from excessive pressure support, may lead to vomiting or regurgitation.