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Respiratory Failure:
General Indications
or
WHEN TO USE NIV and when NOT TO
So why use
noninvasive positive
pressure to ventilate
anyways?
No invasive airway.
no trauma, no risky intubation
Less infection risk
Can take off mask and allow patient to talk,
interact with family, ? Eat
Doesnt have to be in the ICU
A Apnea
B Hemodynamics or cardiac instability
C Low risk of aspiration
Patient Selection
Patient Selection
COPD exacerbations
with initial pH< 7.35
Cardiogenic Pulmonary
Edema
CPAP by mask v/s O2
reduced intubation rate (RR 0.5, CI 0.28,0.63)
Trend towards improved survival (RR 0.84, CI 0.63,1.13)
syndrome
Obesity Hypoventilation Syndrome
Awake
hypercapnia
Obstructive
apnea/ hypopnea
during sleep
1302 patients
21% were treated with NIV as initial management
and 54% avoided intubation
Gristina GR, Antonelli M, Conti G, et al. Noninvasive versus invasive ventilation for acute respiratory failure
in patients with hematologic malignancies: a 5-year multicenter observational survey. Crit Care Med 2011
Failed SBT
Hypercapnia duringRe-intubation
SBT or at rate
extubation
(RR 0.42, CI 0.25,0.70)
Cardiac disease
mortalitywith > 48 hrs
Chronic respiratoryICUdisease
( RR 0.35, CI 0.16,0.78)
ventilation
APACHE II score > 12 at extubation
Postoperative Setting
Treatment of respiratory failure
Prevention of respiratory
failure
468 patients after cardiac
surgery
Pandemics
Can overwhelm
ICUs
Procedures in
high-risk
patients
Key points
Timing of NIV is CRUCIAL to achieve a success
rate; the earlier the better