Patients needing lung recruitment or help with oxygenating will benefit from higher EPAPs and not as large of a delta P/PS-resulting in a lower IPAP setting. high CO 2 or hypercapnia/increased WOB.difficulty oxygenating/requiring lung recruitment.As stated earlier, patients usually fall into two categories: When setting up a patient on NIV, the best guide for choosing your initial numbers originates in the reason the patient would benefit from NIV. For NIV, it is normally set at 12-16 bpm, though most patients on NIV are usually tachypneic due to increased WOB or oxygenation issues. Usually, the RR is set much lower than the patient’s intrinsic RR. Therefore, you can think of the RR as a mandatory breath cycle that can be used as a back-up to ensure the patient continues to trigger breaths at a certain rate. As you have already learned, the patient must be triggering breaths on their own. But, how can you set a respiratory rate for a non-invasive mode where the patient must have an intact drive to breathe? Though it is termed an “RR,” NIV does not use a true respiratory rate. Staying within these starting ranges with slow increases over time will help promote patient tolerance. Pressures should be initiated on the lower side and increased as needed over time to promote patient comfort and decrease the risk of failure of therapy due to patient’s refusal to wear the mask. A tight mask means additional pressure that is being pushed into your patient’s face and may mean that NIV is not tolerated for a conscious patient. Keep in mind as well: the higher the pressures that are used, the tighter the patient’s mask needs to be. Don’t start higher than these levels unless directed by a physician or a practitioner experienced with NIV. Pressures should be started lower first and then adjusted after watching the patient for about 30 minutes and checking the effect with ABGs and overall WOB. Think back to the waveform and mountain analogy from Chapter 4:ĮPAP and IPAP can be increased higher than these initial ranges as needed based on the patient-namely their WOB and issues with CO 2 and oxygen.
This is identical to the Pressure Support in PSV but described a slightly different way in NIV. Think of the change in pressure between the EPAP and the IPAP (delta pressure) as the push to get up to that high level.
The change in pressure is the same as a pressure support or additional pressure given to help augment a person’s breath. The difference between the EPAP and IPAP is the delta pressure or change in pressure. IPAP is the high pressure NIV will cycle up to when the patient initiates a breath. EPAP settings are usually started from 4-8 cmH 20. This means that the distending pressures of EPAP can be lower than the minimum PEEP you must set. The normal pleural pressures that exist with spontaneously breathing patients are still present (see the discussion of lung pressures in Chapter 1). Where it differs from invasive ventilation is using an interface of a face mask instead of intubating and sealing the lungs to a ventilator. It is the distending pressure that helps recruit alveoli and help with oxygenation.
If the patient does not require a lot of oxygen, starting at 0.50 and weaning within a few minutes to target SpO 2 >92% is ideal. If on high oxygen, start FiO 2 at 1.00 and then wean to SpO 2. FiO 2įiO 2 is mandatory to set and should be titrated based on what the patient needed before non-invasive application. These settings will be discussed in detail below.
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