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NIPPV with complete solutions 2024_2025.
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NIPPV with complete solutions 2024_2025.
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NIPPV with complete solutions 2024/2025Benefits of using NIPPV - ANSWER--Provides flexibility in initiating and removing
mechanical ventilation.
-Permits normal eating, drinking and communication.
-Preserves airway mechanisms.
-Reduces WOB.
-Reduces need for heavy sedation.
Benefits of using NIPPV versus invasive ventilation - ANSWER--Avoids airway
trauma.
-Reduces risk of ventilator associated pneumonia.
-Avoids barotrauma and volutrauma.
-Greater comfort, convenience, and less cost.
-Reduces need for invasive monitoring.
Evidences-based guidelines for indications for NIPPV - ANSWER--First option for
ventilatory support for severe exacerbation of COPD. (3 days is too late)
-CPAP for pulmonary edema is just as effective as NIPPV.
-Acute respiratory distress or hypoxemia in post-op setting or in
immunosuppressed patients.
-Early extubation to NIPPV for COPD.
-CPAP for obstructive sleep apnea.
Additional examples of disorders in which NIPPV but with less evidence -
ANSWER--Neuromuscular disorders.
-Central alveolar hypo ventilation: Pickwickian syndrome with morbid obesity.
-Cystic fibrosis.
-Bronchiectasis.
-Do not intubate patients.
, Establishing need for ventilation - ANSWER--Tachycardia.
-Accessory muscle use, and paradoxical breathing.
-ABG results: ph < 7.35 and PaCO2 > 45 mmHg, or PaO2/FiO2 < 200; wide A-a
gradient.
Decision to use NIPPV - ANSWER--Consider the patient's diagnosis, clinical
characteristics and risk of failure.
-May be to early for mild respiratory distress.
-Applying when patient has severe respiratory distress may delay lifesaving
intubation. Key signs: difficulty speaking, limited airflow.
Decision NOT to use NIPPV - ANSWER--Respiratory arrest (apnea) or need for
immediate intubation.
-Impaired airway.
-Excessive secretions.
-Hemodynamics instability.
-Agitated or confused patients.
-Upper airway obstruction.
-Pneumothorax.
-Uncooperative or unmotivated patients.
-Brain injury.
-Other major organ involvement.
-Recent esophageal or gastric surgery.
-Irreversibility of disorder.
-Facial deformities.
Different patient interfaces - ANSWER--Nasal masks.
-Nasal prongs/pillows.
-Full-face mask.
Full face or Oronasal masks - ANSWER--Should fit even if patients mouth is
slightly open.
-Be sure the mask fits well and does not leak excessively. (7-25 for vision and 60
for V60)
-Landmarks: below the lower lip with mouth open, corners of the mouth, just
below the junction of nasal bone and cartilage.
Minimizing leaks - ANSWER--Mask not being correctly seated on face.
-Excessive tension of the head straps. (1-2 fingers between)
-Without full set of teeth.
-Full face or total face mask can help.
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