Analysis of Complications and Transition Timing of Non-Invasive Ventilation

1.What are the complications that require attention during non-invasive ventilation?

1.Flatulence

Flatulence is a common issue that can occur during non-invasive ventilation, especially when the gas pressure is high. The gas can enter the patient's gastrointestinal tract, leading to hiccups, flatulence, and abdominal pain. Furthermore, flatulence can restrict the movement of the diaphragm, which may result in breathing difficulties.

To address flatulence, the following steps can be taken:

1. Reduce suction pressure

2. Decrease gas flow

3. If the patient has a gastric tube, use it to relieve the gas.

4. Adjust the nutrient solution and perfusion speed appropriately.

5. Prevent constipation in patients.

6. Maintain the patient's body position, and raise the head of the bed by >30-35°.

7. Use intermittent off-line method if the patient's respiratory condition permits. High-flow humidified respiratory therapy device can be used to assist breathing and reduce the side effects caused by continuous use of the mask.

2.Patient intolerance to non-invasive ventilation

This problem is not caused by a single reason.It is necessary to find out the cause of patient intolerance through relevant clinical manifestations, such as:

(1) Selection of nasal mask or oral and nasal mask: type, shape, size, tightness and comfort of the mask;

(2) Man-machine confrontation: Whether the ventilator matches the mask, the impact of air leakage on the triggering of the ventilator, the conversion from inhalation to exhalation, the setting of ventilator mode and parameters;

(3) Mental and psychological factors: such as claustrophobia, phobia, etc.;

(4) Changes in the condition: rapid breathing, dyspnea, and non-invasive ventilation cannot meet the patient's needs.

2.When is the switching time between non-invasive ventilation and invasive ventilation?

There are many benefits of non-invasive ventilation, but the function of non-invasive ventilation still cannot replace invasive ventilation under certain conditions.

During non-invasive use, it is necessary to closely monitor the patient's vital signs, arterial blood gas, respiratory status, hemodynamics, changes in consciousness, etc., and timely evaluate the therapeutic effect of non-invasive ventilation on the patient.

The objective criteria for changing from non-invasive to invasive are:

1.Life-threatening hypoxemia (PaO2<50 mmHg or oxygenation index PaO2/FiO2<200 mmHg);

2.Progressive increase in PaCO2 with severe acidosis (pH < 7.20);

3.Severe disturbance of consciousness (such as drowsiness, coma, delirium);

4.Severe respiratory distress (such as respiratory rate > 40 times/min, paradoxical breathing, etc.) or respiratory depression (such as respiratory rate < 8 times/min);

5.Hemodynamic instability;

6.Excessive airway secretions and drainage obstruction, loss of airway protection function;

7.Patients with severe respiratory failure who failed non-invasive treatment.