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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -4 مورد

Protocol for initiation of noninvasive ventilation

Protocol for initiation of noninvasive ventilation
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 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

CPAP: continuous positive airway pressure; NIV: noninvasive ventilation; PSV: pressure support ventilation.

* Care should be taken when using sedatives in patients with underlying lung disorders, especially those with respiratory muscle weakness or neuromuscular disorders.
Adapted with permission from: Mehta S, Hill NS. Noninvasive ventilation. Am J Respir Crit Care Med 2001; 163:540. Copyright © 2001 American Thoracic Society.
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