Tips for rapid NIV acceptance in hospital
Successful NIV depends on a number of factors. One of the most important is patient acceptance. This article contains tips to encourage your patients to quickly acclimatise to NIV.
Selecting the equipment
Selecting the right equipment for NIV consists of identifying the right ventilator for the therapy, the right circuit configuration and an appropriate NIV mask.
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).
You would also use filters or a humidifier as per your hospital policy.
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.
Position the patient
Place your patient in an upright sitting position to assist in reducing the work of breathing, optimise lung expansion, and improve comfort.
Select a mask
Make sure the correct mask size is selected.
Set up the ventilator and commence 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 therapy. 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.
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.
Monitor the patient
Monitor and adjust breath synchronisation with the ventilator. 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 the therapy.
Cairo, JM, 2012, Pilbeam's Mechanical Ventilation: Physiological and Clinical Applications, 5th Ed, Missouri, USA, Mosby Elsevier.
Sorensen, D et al. 2013, Practical wisdom: A qualitative study of the care and management of non-invasive ventilation patients by experienced intensive care nurses, Intensive and Critical Care Nursing Vol 29, 174-81.