NIPPV

Summary

• Indications: hypercapneic COPD (BiPAP), CHF (CPAP), post-extubation prophylaxis, post-operative
• Contraindications: facial trauma, decreased LOC
• NOT to prevent acidosis or to treat post-extubation failure

Definition

• Continuous positive airway pressure (CPAP): provides a single continuous pressure
• Bi-level positive airway pressure (BiPAP): provides difference pressures on inspiration and expiration

Indications

Strong Indications

• COPD with mild to severe acute hypercapneic respiratory failure: BiPAP preferred
  • pH ≤7.35, PaCO2 >45 mmHg, and respiratory rate >20-24 bpm
• Cardiogenic pulmonary edema: CPAP or BiPAP

Moderate Indications

• Obesity hypoventilation syndrome (OHS)
• Post-extubation as prophylaxis for high-risk patients
• Post-operative patients
• Palliative patients, for dyspnea
• Immunocompromised patients

No Data For...

• Asthma
• Respiratory failure without preexisting chronic condition, including pneumonia and ARDS

Avoid In...

• Not to prevent acute respiratory acidosis
• Not to treat post-extubation respiratory failure

Contraindications

• Facial surgery, trauma, or obstruction
• Decreased level of consciousness
• Inability to clear secretions
• Morbid obesity
• Respiratory arrest
• Hemodynamic instability, as it can reduce preload

Further Reading

• Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure (2017)