What’s is the effect of NIV?
Non-invasive positive pressure ventilation
Used to correct respiratory failure I and II
What is the effect of CPAP?
Continuous positive airway pressure
Type of NIV
Used with oxygen to correct hypoxaemja (type I respiratory failure)
- assistance on expiration only
- spontaneously breathing patients
- pressure rather than volume controlled
EPAP/PEEP splints open floppy airways
Recruits collateral channels of ventilation
Increases FRC
Improves gas exchange
Effects of IPPB?
Positive pressure delivered during inspiration
Used in type 1 respiratory failure
- intermittent
- assistance on inspiration only
- can use facemask or mouthpiece
AIM- Recruits lung volume Decrease WOB Raises tidal volume Opens up collapsed alveoli via collateral ventilation Reaches higher pressures than CPAP
Effects PEP?
Positive expiratory pressure
Patient breathes out against a flow to produce positive airway pressure
Promotes airflow past obstruction/recruits collateral ventilation channels
The positive pressure encourages airway splinting to prevent premature airway collapse during expiration
Indications of NIV?
- obstructive sleep apnoea (OSA)
- acute respiratory failure (acute on chronic)
- Nocturnal hypoventilation
- Kyphoscoliosis
- Hypoventilation
Indications of CPAP?
- OSA
- Acute type I respiratory failure
- weaning
Indications for IPPB?
- used in spontaneously breathing patients
- Type 1 respiratory failure
- In patients that are weak, drowsy, or exhausted and have may;
- reduced lung volumes
- increased WOB
- Atelectasis
- Sputum retention
- Neuromuscular disorders who require assisted inhalation
Indications for PEP?
- retained secretions
- Atelectasis
- AECOPD
- Non-CF bronchiectasis
Contraindications to NIV?
- undrained pneumothorax
- severe hypotension
- recent upper GI/thoracic surgery
- cardiac arrhythmias
- Bullous disease
- Epistaxis (haemorrhage from nasal cavity)
- Nasal surgery
- Risk of aspiration-NG tube
Contraindications to CPAP?
- undrained pneumothorax
- Haemoptysis of unknown origin
- Proximal bronchial tumours
- severe hypotension
- Emphysematous bullae
- Lung abscess
- Active TB
Contraindications to IPPB?
- Undrained pneumothorax
- Haemoptysis of unknown cause
- Large bullae
- Large airway carcinoma
- Active/untreated TB
- subcutaneous emphysema
- facial trauma (inc surgery, fractures)
Precautions
- uncontrolled pain
- nausea
- increased intracranial pressure
- unstable cardiovascular status
Contraindications to PEP?
- undrained pneumothorax
- post lung lobectomy/ transplantation
- severe cardiovascular disease
- undrained empyema/ lung abscess
- active haemoptysis
- inability to tolerant due to increased WOB
- facial fractures/surgery
- middle ear infection- increased pressure
Suggested application to CPAP?
5cmH2O- 7.5-10-12.5cmH2O
Alternate increasing PEEP/ FiO2
Remove for airway clearance (risk v benefit)
Time with another treatment e.g. IPPB
Suggest application of IPPB?
15-20 minutes
Initial pressure of 10-15cmH2O
I:E ratio. 1:3 to 1:4
Suggested application of PEP?
Individual required to perform controlled expiration against the resistance, aiming at maintaining expiratory pressure at the mouth of 15cmH2O
Checked by inserted a manometer into the circuit
Repeated for 6-12 breaths
Follow FET
The effect of oscillating PEP?
Offer the combination of PEP with high frequency oscillations within the airways during expiration to facilitate secretions clearance
The expiration resistance is intermittent which induces vibrations within the airway wall to displace secretions
The effect of RMT?
Respiratory muscle training
Weakness of the respiratory muscles= reduction is muscle contractility causing an inability to generate normal levels of pressure and air flow during breathing
Targeting the inspiratory muscles lead to decreased dyspnoea
Improve strength and endurance of diaphragm- tolerant greater inspiratory loads
The effect of IS?
Incentive spirometry
Activated by patient’s inspiratory effort
A slow, deep inspiration performed with lips sealed around the mouthpiece
Visual feedback- a ball rising to a pre-set marker
Tri-flow
The effect of CA?
Cough assist
Uses positive pressure to deliver a maximal lung inhalation followed by a switch to negative pressure to the upper airways
Simulating airflow changes during a cough- assisting sputum clearance
Devices of oscillating PEP available?
- flutter
- acapella
- RC- cornet
- Shaker
Categories of RMT?
Strength
External load device
3 Main categories
- passive flow-resistance
- dynamically adjusted flow- resistance
- pressure threshold valve
Indications for oscillating PEP?
- CF
- Non-CF bronchiectasis
- severe COPD
- retained secretions
- atelectasis
Indications for RMT?
- chronic respiratory disease e.g. COPD, CF
- dyspnoea/ exercise tolerance
- surgical patients
Indications for IS?
Post- surgery- upper abdominal
