Non-invasive ventilation (NIV) is a method of delivering respiratory support without the need for invasive procedures like endotracheal intubation. It typically involves wearing a mask or nasal prongs connected to a ventilator that delivers air or a mixture of air and oxygen to the lungs. NIV is commonly used to treat respiratory conditions such as chronic obstructive pulmonary disease (COPD), pneumonia, and acute respiratory distress syndrome (ARDS). It helps improve oxygenation, reduce work of breathing, and relieve respiratory distress, while allowing patients to remain conscious and communicate. NIV can be administered in various settings, including hospitals, intensive care units, and at home, depending on the patient's condition and needs.

1. NON-INVASIVE VENTILATION
UNDERSTANDING THE PRINCIPLES AND APPLICATIONS

2. CONTENT
 Introduction of NIV
 Indication of NIV
 Contraindication of NIV
 Types of NIV
 Types of NIV masks
 Settings in NIV
 Benefits of NIV
 Challenges and complications

3. INTRODUCTION OF NIV
Definition
The delivering of mechanical ventilation without using a invasive artificial
airway such as endotracheal and tracheostomy tubes.
History:
Non-invasive ventilation (NIV) was first reported in the mid-eighteen century by a
Scottish physician, John Dalziel.In 1864, Alfred F. Jones' patented the first
American tank respirator in the iron lung, known as non-invasive negative
pressure ventilation. In 1938 a new form of NIV was described by Barach et al.
as a treatment for pulmonary edema.

4. INDICATION OF NIV
 Hypercapnic respiratory failure
 Obstructive sleep apnea
 Chronic obstructive pulmonary disease(COPD)
 Acute cardiogenic pulmonary edema
 Asthma
 Post extubation respiratory failure
 Do-not-intubate(DNI)

5. CONTRAINDICATION OF NIV
Absolute contraindication
 Facial trauma/burns
 Fixed upper airway obstruction
 Active vomiting
 Respiratory or cardiac arrest
Relative contraindication
 A recent facial, upper airway or GI surgery
 Inability to product airway
 Life-threatening hypoxia
 Hemodynamic instability

6. CONT…
 Altered mental status
 Bowel obstruction
 Copious of respiratory secretion
 Focal consolidation
 Undrained pneumothrox
 Severe co-morbidity

7. TYPES OF NIV
There are 2 types of NIV they are
 CPAP
 BiPAP

8. CPAP
 Continuous positive airway pressure – mask keep your airways
continuously allowing the air in and out of the lungs.
HOW DOES THE CPAP WORKS?
 The CPAP machine blows normal air at a fixed or prescribed pressure. The
necessary pressure is usually calculated after review of a sleep study
supervised by a sleep physiologist during an overnight stay.
 The mask is held in place by straps or a mesh cap (headgear) to ensure a
good seal around the nose and/or mouth.

9. CONT…
MECHANISM OF ACTION
1. Maintaining airway patency
2. Improving lung compliance and oxygenation
3. Redistribution of pulmonary blood flow
4. Decreasing cardiac workload
5. Preventing atelectasis and V/Q mismatch

10. CONT…
INDICATION OF CPAP
 When a patient remains hypoxic despite medical intervention
 Atelectasis - Complete or partial collapse of a lung or lobe
 Rib fractures - to splint the rib cage open; to stabilise the fracture and prevent
damage to the lung[
 Type I respiratory failure
 Congestive Heart Failure
 Cardiogenic pulmonary edema
 Obstructive sleep apnea
 Pneumonia: as an interim measure before invasive ventilation or as a ceiling
of treatment
 Nasal CPAP is more commonly used with infants

11. BiPAP
 NIV often described as BiPAP
 In BiPAP there is different airway pressure depend on the inspiration and
expiration
 The inspiratory positive airways pressure (iPAP) is higher than the
expiratory positive airways pressure (ePAP)
 ventilation is provided mainly by iPAP, whereas ePAP recruits
underventilated or collapsed alveoli for gas exchange and allows for the
removal of the exhaled gas

12. CONT…
INDICATION OF BiPAP
 Type II respiratory failure
 Acidotic exacerbation of chronic obstructive pulmonary disease (COPD)
 Increased work of breath causing ventilatory failure, for example,
hypercapnia (increased CO2 in arterial blood gas), fatigue or
neuromuscular disorder
 Weaning from tracheal intubation

13. CONT…
MECHANISM OF ACTION
1. Dual pressure support
2. Improving ventilation and oxygenation
3. Enhancing patient comfort and tolerance
4. Treating OSA
5. Management of RF

14. TYPES OF NIV MASKS

15. SETTINGS IN NIV
MODES IN NIV
1. S(spontaneous)
2. ST(spontaneous-timed)
3. iVAPS(intelligent volume-assured pressure support)
4. T(timed)
5. PSV(pressure support ventilation)
6. CPAP(continuous positive airway pressure)
7. AVAPS(average volume-assured pressure support)
8. BiPAP(bilevel positive airway pressure)
9. PCV(pressure control ventilation)

16. CONT…
TYPES OF PRESSURE
1)iPAP
2)ePAP
The ratio of iPAP and ePAP is 12/6
Ipap- 12cmH2O
Epap-6cmH2O

17. BENEFITS OF NIV
 Improve gas exchange
 Avoid intubation
 Decrease mortality
 Decrease length of time on ventilation
 Decrease length of hospitalization
 Reduce risk of complication
 Improve patient comfort and tolerance

18. COMPLICATIONS
 Discomfort
 Erythema
 Nasal congestion
 Nasal dryness
 Eye irritation
 Ear pain
 Claustrophobia
 Gastric distension
 Skin rashes