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What are the Indications and Methods of Noninvasive Ventilation?

Winter is the most common time of year for acute exacerbations in patients with chronic obstructive pulmonary disease. These patients are often treated clinically with non-invasive ventilation. Do you know all the basic skills of non-invasive ventilation?

I. What are the indications for non-invasive ventilation?

Clinically, for patients with sleep apnoea syndrome, it is usually used only when the patient is asleep; for patients with amyotrophic lateral sclerosis (ALS), early intermittent use is usually advocated; for patients with stable COPD with CO2 retention, it is usually used when the patient feels short of breath and has difficulty breathing.

The European Respiratory Society/American Thoracic Society guidelines and the Chinese Expert Consensus recommend that noninvasive ventilation should be used when a patient is hospitalised with acute respiratory failure or an acute exacerbation of chronic respiratory failure with AECOPD.

What is the timing of noninvasive ventilation in acute respiratory failure?

We can classify acute respiratory failure into three different levels (mild, moderate and severe). niv non invasive ventilation should be administered between mild and moderate respiratory failure, determined by clinical experience and arterial blood gases.

If the patient's respiratory failure does not improve with conventional treatment (oxygen therapy, bronchodilation, hormonal therapy) or tends to worsen persistently, non-invasive positive pressure assisted ventilation should be administered as soon as possible. If the patient's respiratory failure does not improve significantly within 30 min to 1 h after the administration of niv non invasive ventilation, the patient should be transferred to the ICU to be prepared for invasive ventilation (unless the patient or family refuses).

II. What are the modes of ventilation for non-invasive ventilation?

We will focus on the 2 most common types of NIV non invasive ventilation.

1. Continuous positive airway pressure ventilation (CPAP)

Continuous positive airway pressure (CPAP) is a non-invasive form of mechanical ventilation that delivers a constant flow of air through a mask to keep the airways open and prevent collapse. It is commonly used to treat sleep apnea, a condition characterized by recurrent episodes of upper airway obstruction during sleep. CPAP therapy can improve the quality of sleep, alleviate excessive daytime sleepiness, and reduce the symptoms of sleep apnea.

2. Biphasic positive airway pressure ventilation (BiPAP)

Biphasic positive airway pressure (BiPAP) is a form of non-invasive mechanical ventilation that delivers two levels of pressure: a higher pressure for inspiration and a lower pressure for expiration. BiPAP is similar to continuous positive airway pressure (CPAP), but it allows for more flexibility in breathing patterns and can be used to treat a wider range of respiratory disorders. It is often used in patients with sleep apnea, chronic obstructive pulmonary disease (COPD), and other respiratory conditions that cause difficulty breathing. BiPAP therapy can help improve breathing, reduce shortness of breath, and increase oxygen levels in the blood.

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