Lightning Learning: Non-Invasive Ventilation (NIV)
STOP!
Patients who are in acute hypercapnic/type 2 respiratory failure (defined as pH <7.35, PCO2 >6.0 on an arterial blood gas) may need NIV to stabilise their situation.
Requiring acute NIV is associated with up to 50% mortality within 1 year.(1)
Consider referral to ICU when…
- SpO2 <88% with maximum oxygen
- Arterial pH <7.25
- Haemodynamic instability
- Inability to protect airway
Remember to discuss and document an escalation plan and resuscitation status before starting NIV.
LOOK
Treat reversible causes such as a COPD exacerbation, if able give trial of nebulisers and steroids and repeat ABG to see if NIV is still indicated.
When starting NIV:
NIPPY 3+ pressure support mode settings (apply siltape):
- IPAP 10.0, EPAP 4.0 (cmH2O)
- Back-up rate 12 BPM
- Ti 1.0, alarms ‘Hi’ 160, ‘Lo’ 20
Increase IPAP by 2-2.5 every 5 mins to max 20, as tolerated. Connect oxygen and nebuliser tubing if required.
Repeat ABG after 30 minute trial.
LEARN
NIV is an Aerosol Generating Procedure.
Offer lidocaine for ABGs.
References & Further Learning
- BTS/ICS Guidelines for the Ventilatory Management of Acute Hypercapnic Respiratory Failure in Adults (BTS)
- Use of acute NIV in patients hospitalised with suspected or confirmed COVID-19 infection (BTS)
Many thanks to Dr Sarah Edwards for her help with reviewing this poster 👍
