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Analysis of Non-invasive Ventilation Complications and Conversion Timing

I. Key Complications to Watch for During Non-invasive Ventilation

  1. Gastrointestinal Bloating One of the most common complications during non-invasive ventilation is gastrointestinal bloating, particularly under high gas pressure. When gas enters the gastrointestinal tract, it can cause belching, bloating, and abdominal pain in patients. Additionally, gastrointestinal bloating can impact the movement of the diaphragm and make breathing difficult.

To address gastrointestinal bloating, the following strategies can be implemented:

  • Decreasing inhalation pressure

  • Reducing gas flow

  • Using a gastric tube to evacuate gas, if available

  • Adjusting the type and infusion rate of the nutrition solution

  • Preventing constipation to minimize bloating

  • Keeping the patient in an upright position and elevating the head of the bed to more than 30-35°

  • Intermittently decannulating and using a high-flow humidifier to assist breathing if the patient's breathing condition allows, reducing the side effects of continuous mask use.

  1. Patient Intolerance to Non-invasive Ventilation Intolerance to non-invasive ventilation can have multiple causes. To determine the reason for a patient's intolerance, the following factors should be considered:

  • Selection of a nasal or oral-nasal mask: including its type, shape, size, tightness, and comfort level

  • Human-machine compatibility: considering the fit of the ventilator and mask, the impact of leaks on ventilator triggering, the conversion from inhalation to exhalation, and the settings of the ventilator mode and parameters

  • Psychological and mental factors: such as claustrophobia or phobias

  • Changes in the patient's illness, including rapid breathing, difficulty breathing, or inadequate support from non-invasive ventilation.

II. Conversion from Non-invasive to Invasive Ventilation

While non-invasive ventilation has many benefits, there are certain circumstances where it may not be effective enough and must be converted to invasive ventilation. Patients should be closely monitored during non-invasive ventilation, and the conversion should occur promptly if:

  • The patient's respiratory function deteriorates and non-invasive ventilation is no longer effective

  • The patient's airway obstruction increases and non-invasive ventilation is no longer effective

  • The patient's vital signs decline, and non-invasive ventilation cannot ensure their safety

  • The patient's mental and psychological state deteriorates, making non-invasive ventilation intolerable.

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