Titration modules for noninvasive ventilation in patients with chronic respiratory failure due to neuromuscular or chest wall diseases

This algorithm describes the general approach to titrating NIV in patients with chronic respiratory failure due to neuromuscular or chest wall disease. The approach may need to be individualized depending upon the patient's tolerance of NIV. Refer to UpToDate content on NIV mode selection and the preparatory steps needed to begin NIV trials.

NIV: noninvasive ventilation; IPAP: inspiratory pressure; EPAP: maximum expiratory pressure; bpm: breaths per minute; Vt: tidal volume; IBW: ideal body weight; PEEP: positive end-expiratory pressure; AVAPS: average volume-assured pressure support; IVAPS: intelligent volume-assured pressure support; IPAPmin: minimum inspiratory pressure; IPAPmax: maximum inspiratory pressure.

* Patients with obstructive sleep apnea may require higher EPAP or PEEP, which may need to be determined in the sleep laboratory.

¶ During titration, small air leaks may be tolerated particularly if the patient is comfortable and improving. If air leak is substantial, this may be addressed in future trials typically with further adjustment in the settings that are targeted at increasing the degree of support or tidal volume.

Δ A trial at home or the office typically lasts for 1 to 2 hours while those that are performed in the hospital or sleep laboratory may last for longer, typically during sleep or as long as is tolerated.

Graphic 138401 Version 1.0

خرید پکیج

Titration modules for noninvasive ventilation in patients with chronic respiratory failure due to neuromuscular or chest wall diseases