Добавил:
Upload Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз: Предмет: Файл:
Rajesh_Chawla_-_ICU_Protocols_A_stepwise_approa[1].pdf
Скачиваний:
259
Добавлен:
13.03.2016
Размер:
9.49 Mб
Скачать

3 Noninvasive Positive-Pressure Ventilation

29

 

 

It is extremely important for the air seal to be tight. Ulceration and pressure necrosis related to local skin effects commonly occur at the bridge of the nose. Protective synthetic coverings may help prevent skin breakdown and ulceration on the bridge of the nose.

Eye irritation and pain or congestion of the nasal sinuses may occur. Put some decongestant nasal drops.

Distension of the stomach due to aerophagia and aspiration can occur secondary to vomiting. A nasogastric tube can be used to relieve the distension while still allowing the mask to seal.

Adverse hemodynamic effects from NIPPV are unusual, although preload reduction and hypotension may occur. Give intravenous fluids.

Step 6: Discontinuation of NIPPV

It is very important to know when to discontinue NIPPV and intubate and ventilate the patient.

NIPPV failure

Worsening mental status

Deterioration of pH and PaCO2 after 1–3 h of therapy

Refractory hypoxemia—when even a brief discontinuation of NIPPV leads to significant fall in oxygen saturation

Intolerance to NIPPV

Hemodynamic instability.

Inability to clear secretions.

Step 7: Weaning

Initially, give NIPPV continuously as long as possible.

Once the patient is tolerating periods off NIPPV, start discontinuing during daytime and give during nighttime. In 2–3 days, the patient can be weaned off the NIPPV.

A brief outline of the application of NIPPV is shown in Fig. 3.1.

Suggested Reading

1.Ambrosino N, Vagheggini G. Noninvasive positive pressure ventilation in the acute care setting: where are we? Eur Respir J. 2008;31(4):874–86.

A comprehensive review focusing on recent developments for the application of NIPPV in the treatment of acute and acute-on-chronic respiratory failure.

2.Majid A, Hill NS. Noninvasive ventilation for acute respiratory failure. Curr Opin Crit Care. 2005;11(1):77–81.

This review critically examines the recent literature related to applications of noninvasive ventilation in the acute setting.

3.Confalonieri M, Garuti G, Cattaruzza M-S, et al. A chart of failure risk for noninvasive ventilation in patients with COPD exacerbation. Eur Respir J. 2005;25(2):348–55.

4.Schönhofer B, Sortor-Leger S. Equipment needs for noninvasive mechanical ventilation. Eur Respir J. 2002;20(4):1029–36.

A review of the equipment, location, and troubleshooting during the use of noninvasive ventilation in ARF

30

R. Chawla and S. Todi

 

 

Website

1.http://www.isccm.org/edu_guidelines.htm

ISCCM Guidelines—comprehensive guidelines dealing with every aspect of NIPPV

Соседние файлы в предмете [НЕСОРТИРОВАННОЕ]