Tips for rapid non-invasive ventilation (NIV) acceptance in hospital

Successful non-invasive ventilation treatment depends on a number of factors. One of the most important is patient acceptance. This article contains tips to encourage your patients to quickly get accustomed to NIV.

1. Select the equipment

Selecting the right equipment for non-invasive ventilation consists of identifying the right ventilator for the therapy, the right circuit configuration and an appropriate NIV mask. Our non-invasive ventilation devices feature world-class technology and intuitive design features, with menu options that allow low-touch therapy setup and adjustment.

Vented NIV masks (which allow removal of exhaled CO2 via vents in the mask system) are used with a device that requires a single limb circuit. Non-vented NIV masks are used with devices that have a built-in expiration valve in the circuit or allow patients to expire through the expiratory block (used with a dual circuit). Learn about our range of AcuCare masks. You may also use humidifiers, filters and other accessories per your hospital policy.

2. Explain the therapy to the patient

Ensure that the patient understands what you are going to do so you can gain their cooperation, alleviate any fears and reduce their anxiety.

3. Position the patient

If possible, have your patient sit in an upright position to help reduce the work of breathing, optimize lung expansion and improve comfort.

4. Select a mask

Make sure to select the correct mask size, paying attention to the instructions on the quick fitting guide. (Tip: with ResMed's AcuCare masks, use the fitting template on the side of the packaging for quick, easy and accurate sizing).

5. Set up the ventilator and begin therapy

Once the ventilator is set up with the right circuit and mask, you may need to complete a Learn Circuit. Check with the ventilator manufacturer guidelines.

Start therapy at low pressures. Hold the mask (or allow the patient to hold the mask) to their face until they become comfortable with the airflow. Then attach the straps to hold the mask in place, and slowly increase pressure to the desired settings. Continue to coach and reassure your patient.

6. Titrate oxygen delivery

Titrate the level of oxygen, inspiratory and expiratory positive airway pressures (IPAP/EPAP or PS and PEEP). The goal is to achieve adequate exhaled tidal volume, control respiratory rate, improve oxygenation, reduce the work of breathing and improve patient comfort.

7. Monitor the patient

Monitor and adjust breath synchronization with the ventilator. Learn more about the synchrony features on our NIV devices.

Manage any mask leak by adjusting the straps as required. Continue to monitor respiratory rate, oxygen saturations, tidal volume, minute volume, work of breathing and arterial blood gases as per your hospital policy guidelines.

Monitor your patient’s comfort levels, adjusting the mask and settings as required and continuing to coach and reassure your patient through therapy.

References

  • 01

    Cairo, JM 2012. Pilbeam's Mechanical Ventilation: Physiological and Clinical Applications, 5th Ed, Missouri, USA, Mosby Elsevier.

  • 02

    Bello G et al. Noninvasive ventilation: practical advice. Curr Opin Crit Care 2013;19(1):1–8.

  • 03

    Sorensen D et al. Practical wisdom: A qualitative study of the care and management of non-invasive ventilation patients by experienced intensive care nurses. Intensive Crit Care Nurs 2013;29:174–81.

  • 04

    Cross AM. Non-invasive ventilation in critical care. Intern Med J 2012;42(5):35–40.

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