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Noninvasive positive pressure ventilation (NPPV) should be considered only for patients who are breathing spontaneously.
Leaks and resistance in interface devices may reduce or eliminate the machine's ability to maintain the set pressure level.
Because of the risk of aspiration, do not restrain patients requiring a face mask on NPPV. The patient should be able to remove the mask in the event of vomiting.
NPPV is delivery of ventilatory support without the placement of an artificial airway (an endotracheal tube or tracheostomy); ventilatory support is provided through a nasal mask, nasal pillows, full-face mask, or helmet mask. NPPV is used to prevent airway obstruction during sleep; to maintain or improve ventilation, oxygenation, or both; and to provide respiratory muscle rest in patients in whom invasive mechanical ventilation is not possible, acceptable, or desired.1 Continuous positive airway pressure (CPAP) is the provision of continuous positive airway pressure throughout inspiration and expiration; bilevel positive airway pressure (BiPAP) is the administration of two levels of airway pressure, one during inspiration and another during expiration.
Modes of NPPV include CPAP and BiPAP:
Indications for NPPV include:
Absolute contraindications for NPPV include:
Relative contraindications for NPPV include:
An interface is the device that connects the noninvasive ventilator to the patient's airway.
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Rationale: Inappropriate interfaces and headgear reduce the effectiveness of NPPV and may increase complications and decrease compliance. Headgear is needed to stabilize the interface.
Avoid placing the mask too high over the eyes because doing so can create a leak in the system and can cause eye irritation.
Rationale: Assessing patterns of breathing and synchrony with the machine ensures delivery of a set pressure. Adequate support decreases a rapid and shallow breathing pattern and promotes a slower and deeper pattern.
Report ventilatory asynchrony to the practitioner.
Rationale: An ill-fitting mask affects the delivery of adequate pressure.
Reportable conditions: Visible secretions in the airway, inspiratory wheezes, expiratory crackles, diminished breath sounds, increased work of breathing, tachypnea, shallow respirations, tachycardia or bradycardia, hypertension or hypotension, cyanosis.
Reportable conditions: An ill-fitting interface and leaks around the interface
Rationale: NPPV can lead to increased gas flow to the stomach. Decompression of the stomach may be necessary.
Reportable conditions: Gastric distention, nausea, vomiting
Rationale: Increased secretions may impede ventilation.
Reportable conditions: Increased oral, nasal, or respiratory secretions
Rationale: Impaired skin integrity increases the risk of infection. The bridge of the nose and the cheeks are prone to skin breakdown.
Reportable condition: Pressure injury related to interface
Kelly, C.R., Higgins, A.R., Chandra, S. (2015). Videos in clinical medicine. Noninvasive positive-pressure ventilation. New England Journal of Medicine, 372(23), e30. doi:10.1056/NEJMvcm1313336
Adapted from Wiegand, D.L. (Ed.). (2017). AACN procedure manual for high acuity, progressive, and critical care (7th ed.). St. Louis: Elsevier.
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