Every Breath They Take: NIPPV JIU-JITSU
Download MP3In this episode of the FlightBridgeED Podcast, Dr. Michael Lauria dives deep into the art and science of non-invasive positive pressure ventilation (NIPPV), exploring how to optimize CPAP and BiPAP for critically ill patients. Discover advanced techniques to fine-tune ventilator settings, evaluate effectiveness, and reduce mortality and morbidity in COPD, CHF, and other conditions. Learn how to align ventilatory support with patient pathophysiology and understand the tools that predict success or failure in non-invasive ventilation.
Whether you're a seasoned critical care provider or just starting to explore advanced practice concepts, this episode offers valuable insights to elevate your understanding of respiratory management.
Listen anywhere you get your podcasts or directly on our website at flightbridgeed.com/fbe-podcast. While there, explore our award-winning courses and resources designed to empower healthcare professionals.
Takeaways
- Advanced Insight: Using effective PEEP and pressure support in BiPAP can dramatically reduce breathing work and improve outcomes for COPD and CHF patients.
- Practical Guidance: Titrating CPAP and BiPAP requires continuous evaluation of patient response and adjusting settings like pressure support, PEEP, rise time, and expiratory trigger.
- Foundational Knowledge: Understanding when and why to choose non-invasive ventilation based on patient pathophysiology is critical for improving care quality.
References
1. Bello G, De Santis P, Antonelli M. Non-invasive ventilation in cardiogenic pulmonary edema. Ann Transl Med. Sep 2018;6(18):355. doi:10.21037/atm.2018.04.39
1. Bello G, De Santis P, Antonelli M. Non-invasive ventilation in cardiogenic pulmonary edema. Ann Transl Med. Sep 2018;6(18):355. doi:10.21037/atm.2018.04.39
2. Berbenetz N, Wang Y, Brown J, et al. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema. Cochrane Database Syst Rev. Apr 5 2019;4(4):Cd005351. doi:10.1002/14651858.CD005351.pub4
3. Carrillo A, Lopez A, Carrillo L, et al. Validity of a clinical scale in predicting the failure of non-invasive ventilation in hypoxemic patients. J Crit Care. Dec 2020;60:152-158. doi:10.1016/j.jcrc.2020.08.008
4. Chong CY, Bustam A, Noor Azhar M, Abdul Latif AK, Ismail R, Poh K. Evaluation of HACOR scale as a predictor of non-invasive ventilation failure in acute cardiogenic pulmonary oedema patients: A prospective observational study. Am J Emerg Med. May 2024;79:19-24. doi:10.1016/j.ajem.2024.01.044
5. Coleman JM, 3rd, Wolfe LF, Kalhan R. Noninvasive Ventilation in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc. Sep 2019;16(9):1091-1098. doi:10.1513/AnnalsATS.201810-657CME
6. Conti G, Antonelli M, Navalesi P, et al. Noninvasive vs. conventional mechanical ventilation in patients with chronic obstructive pulmonary disease after failure of medical treatment in the ward: a randomized trial. Intensive Care Med. Dec 2002;28(12):1701-7. doi:10.1007/s00134-002-1478-0
7. D'Andrea A, Martone F, Liccardo B, et al. Acute and Chronic Effects of Noninvasive Ventilation on Left and Right Myocardial Function in Patients with Obstructive Sleep Apnea Syndrome: A Speckle Tracking Echocardiographic Study. Echocardiography. Aug 2016;33(8):1144-55. doi:10.1111/echo.13225
8. Duan J, Chen L, Liu X, et al. An updated HACOR score for predicting the failure of noninvasive ventilation: a multicenter prospective observational study. Crit Care. Jul 3 2022;26(1):196. doi:10.1186/s13054-022-04060-7
9. Duan J, Han X, Bai L, Zhou L, Huang S. Assessment of heart rate, acidosis, consciousness, oxygenation, and respiratory rate to predict noninvasive ventilation failure in hypoxemic patients. Intensive Care Med. Feb 2017;43(2):192-199. doi:10.1007/s00134-016-4601-3
10. Duan J, Yang J, Jiang L, et al. Prediction of noninvasive ventilation failure using the ROX index in patients with de novo acute respiratory failure. Ann Intensive Care. Dec 5 2022;12(1):110. doi:10.1186/s13613-022-01085-7
11. Esnault P, Cardinale M, Hraiech S, et al. High Respiratory Drive and Excessive Respiratory Efforts Predict Relapse of Respiratory Failure in Critically Ill Patients with COVID-19. Am J Respir Crit Care Med. Oct 15 2020;202(8):1173-1178. doi:10.1164/rccm.202005-1582LE
12. Ferreyro BL, De Jong A, Grieco DL. How to use facemask noninvasive ventilation. Intensive Care Med. May 27 2024;doi:10.1007/s00134-024-07471-y
13. Giovannini I, Chiarla C, Boldrini G, Terzi R. Quantitative assessment of changes in blood CO2 tension mediated by the Haldane effect. Journal of Applied Physiology. 1999;87(2):862-866. doi:10.1152/jappl.1999.87.2.862
14. Ho KM, Wong K. A comparison of continuous and bi-level positive airway pressure non-invasive ventilation in patients with acute cardiogenic pulmonary oedema: a meta-analysis. Crit Care. 2006;10(2):R49. doi:10.1186/cc4861
15. Klocke RA. Mechanism and kinetics of the Haldane effect in human erythrocytes. Journal of Applied Physiology. 1973;35(5):673-681. doi:10.1152/jappl.1973.35.5.673
16. Leatherman J. Mechanical ventilation for severe asthma. Chest. Jun 2015;147(6):1671-1680. doi:10.1378/chest.14-1733
17. Lenique F, Habis M, Lofaso F, Dubois-Randé JL, Harf A, Brochard L. Ventilatory and hemodynamic effects of continuous positive airway pressure in left heart failure. Am J Respir Crit Care Med. Feb 1997;155(2):500-5. doi:10.1164/ajrccm.155.2.9032185
18. Martin JG, Shore S, Engel LA. Effect of continuous positive airway pressure on respiratory mechanics and pattern of breathing in induced asthma. Am Rev Respir Dis. Nov 1982;126(5):812-7. doi:10.1164/arrd.1982.126.5.812
19. Nava S, Carbone G, DiBattista N, et al. Noninvasive ventilation in cardiogenic pulmonary edema: a multicenter randomized trial. Am J Respir Crit Care Med. Dec 15 2003;168(12):1432-7. doi:10.1164/rccm.200211-1270OC
20. Osadnik CR, Tee VS, Carson-Chahhoud KV, Picot J, Wedzicha JA, Smith BJ. Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. Jul 13 2017;7(7):Cd004104. doi:10.1002/14651858.CD004104.pub4
21. Peter JV, Moran JL, Phillips-Hughes J, Graham P, Bersten AD. Effect of non-invasive positive pressure ventilation (NIPPV) on mortality in patients with acute cardiogenic pulmonary oedema: a meta-analysis. Lancet. Apr 8 2006;367(9517):1155-63. doi:10.1016/s0140-6736(06)68506-1
22. Rittayamai N, Pravarnpat C, Srilam W, Bunyarid S, Chierakul N. Safety and efficacy of noninvasive ventilation for acute respiratory failure in general medical ward: a prospective cohort study. J Thorac Dis. Oct 31 2023;15(10):5466-5474. doi:10.21037/jtd-23-732
23. Rochwerg B, Brochard L, Elliott MW, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. Aug 2017;50(2)doi:10.1183/13993003.02426-2016
24. Sequeira TCA, BaHammam AS, Esquinas AM. Noninvasive Ventilation in the Critically Ill Patient With Obesity Hypoventilation Syndrome: A Review. J Intensive Care Med. Aug 2017;32(7):421-428. doi:10.1177/0885066616663179
25. Stefan MS, Nathanson BH, Lagu T, et al. Outcomes of Noninvasive and Invasive Ventilation in Patients Hospitalized with Asthma Exacerbation. Ann Am Thorac Soc. Jul 2016;13(7):1096-104. doi:10.1513/AnnalsATS.201510-701OC
26. Tyuma I. The Bohr effect and the Haldane effect in human hemoglobin. Jpn J Physiol. 1984;34(2):205-16. doi:10.2170/jjphysiol.34.205
27. Vital FM, Ladeira MT, Atallah AN. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema. Cochrane Database Syst Rev. May 31 2013;(5):Cd005351. doi:10.1002/14651858.CD005351.pub3
28. Weng CL, Zhao YT, Liu QH, et al. Meta-analysis: Noninvasive ventilation in acute cardiogenic pulmonary edema. Ann Intern Med. May 4 2010;152(9):590-600. doi:10.7326/0003-4819-152-9-201005040-00009