1. Non-invasive Ventilation

2. What is NIV?
Non-Invasive Positive Pressure Ventilation (NPPV) refers to the provision of ventilatory support through the patient’s upper airway using a mask or similar device
NIV should be available 24 hours a day in hospitals admitting patients in acute hypercapnic respiratory failure (British Thoracic Society, 2002)
Different types of NIV include High Flow Oxygen Therapy (HFT), Continuous Positive Airway Pressure (CPAP), pressure controlled ventilation (more commonly known as BiPAP) and volume controlled ventilation (not often used in children)

3. When to use NIV
May be used for both acute and chronic respiratory problems
May be used both at home and in the hospital setting
In an acute setting, the commencement of therapy is usually dictated by the patient’s work of breathing, blood gases and oxygen requirements
Chronic use will be dictated by sleep studies and individual need and condition

4. Conditions that NIV is commonly used for
Acute conditions
Bronchiolitis
Pertussis
Pneumonia
Chronic conditions
Central Hypoventilation
Duchenne’s muscular dystrophy
SMA (Spinal Muscular Atrophy)
Tracheomalacia and bronchomalacia

5. What does NIV do?
Used to overcome mechanical problems with the airway,lungs or chest wall
Rest fatigued inspiratory muscles
Support upper airway collapse
To regulate gas exchange
Normalise CO2 levels
Treat acidosis
Increase oxygenation and reverse hypoxia
To increase lung volume
Treat hypoxemic respiratory failure
Prevent/treat atelectasis
Increase PEEP
Optimise work of breathing

6. Types of NIV used at JR High flow oxygen therapy
Optiflow
Vapotherm
This delivers a flow of warmed gas that exceeds the patients respiratory demand so facilitating flushing of the dead space of the upper airway.
CPAP is not provided however it is thought that a 5-8cmH2O pressure may be acheived in some patients.

7. Types of NIV used at JR Advantages of HFT
Patient compliance will be similar to that as when using nasal cannula oxygen therapy.
Minimal risk of pressure areas developing.
Disadvantages of HFT
Gases need to be humidified to body temperature with 100% relative humidity therefore requiring the equipment to facilitate this.

8. Types of NIV used at JR Continuous positive airway pressure (CPAP)
CPAP drivers including SiPAP
V60 and Trilogy
NIPPY
This provides positive airway pressure throughout the breathing cycle, restoring functional residual capacity to prevent collapse and lessen work of breathing

9. Types of NIV used at JR Advantages of CPAP
Can be used for spontaneously breathing patients
Disadvantages of CPAP
Compliance may be poor
Patient must have an intact respiratory drive as there is no backup rate
Increased risk of pressure areas developing
Specialist equipment needs to be used to deliver the pressure and monitor it adequately

10. Types of NIV used at JR BiPAP
V60 AND Trilogy
NIPPY
This provides positive pressure throughout the breathing cycle with a higher pressure delivered during inspiration
This results in reduced work of breathing and improvement in tidal volume and CO2 removal

11. Types of NIV used at JR Advantages
Improves work of breathing so decreasing respiratory effort
Most equipment will support spontaneously breathing patients as well as delivering breaths for patients that are having apnoeas
Disadvantages
Compliance may be poor
Increased risk of pressure areas developing
Specialist equipment needs to be used to deliver the pressure and monitor it adequately

12. Terminology EPAP/CPAP/PEEP IPAP/PIP iT/Ti Backup rate
Expiratory positive airway pressure
Continuous positive airway pressure
Positive end expiratory pressure
IPAP/PIP
Inspiratory positive airway pressure
Positive inspiratory pressure
iT/Ti
Inspiratory time
Backup rate
Tidal volume/TV/VTi/VTe
Minute volume/MV/Min vent
MAP
Mean airway pressure

13. Contraindications Craniofacial trauma or burns Basal skull fractures
Recent facial, oesophageal or gastric surgery
Uncooperative patient
Consider whether NIV is the best option

14. Care of a child on NIV Consent Child and family support/education
Pressure area care
NGT
IVI
Secretion clearance

15. Any questions?

16. Time for NIV