Noninvasive Positive Pressure Ventilation (NIPPV) Expiratory & Inspiratory Positive Airway Pressure Both increase intrathoracic pressure, which can decrease venous return. Both can decrease LV afterload by reducing LV transmural pressure, potentially improving SV. EPAP prevents upper & lower airway collapse and can "recruit" alveoli'. IPAP can help generate larger VT and decreases respiratory fatigue, especially in obstructive lung and neuromuscular disease. CPAP - Continuous Positive Airway Pressure - Provides EPAP. In CHF, decreases intubation and mortality BPAP - Bi-Level Positive Airway Pressure - Provides both EPAP and IPAP. In COPD, decreases intubation, mortality, LOS NIPPV Indications: • CHF exacerbation (cardiogenic pulmonary edema) • COPD exacerbation (often w/ acute on chronic resp acidosis) • Post-extubation in high risk patients (ie., CHF or COPD) • Other acute respiratory failure (ie.. asthma exacerbation) • Chronic respiratory failure (ie OHS and neuromuscular dz) • Pt is DNI with indication for intubation • Palliation for increased WOB, dyspnea NIPPV Contraindications: • Risk of Aspiration - unable to clear secretions, altered mental status • Won't Work - Cannot initiate breath, Anatomic deformity (facial trauma, surgery, excess facial hair) • Risk Of Clinical Worsening - Cannot tolerate decreased preload, Recent intrathoracic damage (pneumothorax. esophageal injury, intrathoracic procedure/surgery) Dr. Meredith Greer @EmmGeezee #Noninvasive #PositivePressure #Ventilation #NIPPV #CPAP #BPAP #indications #criticalcare #management
