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Non-invasive ventilation (Disadvantages (Claustrophobia, Agitation,…
Non-invasive ventilation
Indications
Hypercapnic resp failure
COPD
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Reduces WOB
In inspiration: less pressure change that must be generated to initiate resp in presence of auto-PEEP
Expiration: opposing dynamic airway compression and allowing more complete expiration with less gas trapping and hyperinflation
Good evidence: Cochrane review - reduced mortality and need for invasive vent (with associated invaseive complications VAP, sedation
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Not useful in NM disorders (e.g. Guillian Barre syndrome) - does not solve the problem of inability to eliminate secretions, may increase incidence of aspiration
Hypoxaemic resp failure
Cardiogenic PO
Reduces preload and afterload, redistributes alveolar fluid and reduces WOB
Good evidence - Cochrane review: reduces mortality and need for invasive ventilation with no increase in MI
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Immunocompromised patients: Reduces mortality and need for invasive ventilation (increased susceptibility to VAP and mortality)
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Contraindications
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Relative
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Conditions where air swallowing may cause problems e.g. oesophagectomy - leak at anastamosis (controversial)
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Delivery
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The pressures (CPAP and insp press) are started at a baseline which is well tolerated (e.g. 5 and 8) and are slowly titrated to achieve targets (oxygenation, reduce WOB, ensure TV)
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