| Initiation |
- Appropriately monitored location, oximetry, respiratory impedance, vital signs as clinically indicated
- Patient in bed or chair at >30-degree angle
- Select and fit interface
- Select ventilator
- Apply headgear; avoid excessive strap tension (one or two fingers under strap)
- Connect interface to ventilator tubing and turn on ventilator
|
| Initial settings |
| Bilevel NIV | CPAP | PSV |
- Start with low pressure in spontaneously triggered mode with backup rate: Inspiratory pressure at 8 to 12 cm H2O; Expiratory pressure at 3 to 5 cm H2O
- Gradually increase inspiratory pressure (10 to 20 cm H2O) as tolerated to achieve alleviation of dyspnea, decreased respiratory rate, increased tidal volume (if being monitored), and good patient-ventilator synchrony
- Provide O2 supplementation as needed to keep O2 saturation >90%
| - CPAP level at 5 to 8 cm H2O
- Gradually increase CPAP level as tolerated (up to 20 cm H2O) to achieve improvement in dyspnea and reduction in respiratory rate
- Provide O2 supplementation as needed to keep O2 saturation >90%
| - Inspiratory pressure at 8 to 12 cm H2O
- Positive end-expiratory pressure at 3 to 5 cm H2O
- Gradually increase inspiratory pressure to maximum of 20 cm H2O to achieve improvement in dyspnea and reduction in respiratory rate
|
| Follow-up |
- Check for air leaks, readjust straps as needed
- Add humidifier as indicated
- Consider mild sedation (eg, intravenously administered lorazepam 0.5 mg) in agitated patients*
- Encouragement, reassurance, and frequent checks and adjustments as needed
- Monitor occasional blood gases (within 1 to 2 hours) and then as needed
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