Noninvasive Positive Pressure Ventilation NIPPV,Indications,Criteria

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PRACTICAL GUIDELINES FOR MECHANICAL VENTILATION

Special Modes Of Ventilation

Related topics

Summary and Introduction

Objectives Of Mechanical Ventilation

Indications For Mechanical Ventilation

Mechanical Ventilatory Support

Ventilation Strategies

Giuseppe A. Marraro, MD
Director
Department of Anesthesia and Intensive Care
Pediatric Intensive Care Unit
Fatebenefratelli and Ophthalmiatric Hospital
Milano Italy

Correspondence:
Corso Porta Nuova 23 - I 20121, Milano, Italy. E-Mail gmarraro@picu.it

Continued...

SPECIAL MODES OF VENTILATION :

2. Non-Invasive Positive Pressure Ventilation - NIPPV: The feasibility of applying a ventilatory mode capable of avoiding airway invasion has been evaluated and tested over time. Two modes using different methodologies to attain respiration have had large consensus: 1) Negative Pressure Ventilation by means of either iron lung or chest cuirass (42-44), and 2) Positive Pressure Ventilation in spontaneous breathing, with CPAP, or Non-invasive Positive Pressure Ventilation with mask (45-47).

A new ventilatory mode has been recently introduced in clinical practice, which uses biphasic negative and positive external pressure to obtain gas exchange (Figure 8).

Figure 8 - External cuirass is useful to apply biphasic external negative and positive pressure ventilation.

Figure 8 - External cuirass is useful to apply biphasic external negative and positive pressure ventilation.

Most tested indications:

to treat neuromuscular and chronic obstructive pulmonary disease
to reduce respiratory fatigue and rest respiratory muscles
home assistance.

General criteria for NPPV application in pediatric age:

Moderate or severe dyspnea
Use of accessory muscles and paradoxical abdominal respiration
Severe deterioration of gas exchange with PaCO2 >45 and/or pH < 7.35 or PaO2/FiO2 < 300.

Eligibility criteria:

awake and collaborative child
hemodynamic stability
no abundant secretions
presence of airway protective reflexes
absence of facial trauma or anatomical malformation
no gastrointestinal bleeding.

Exclusion criteria (48) :

unconsciousness, not collaborating or agitated patient
respiratory arrest
hemodynamic instability (hypotension, arrhythmia, etc.)
insufficient protection of airways (lack of cough, abundant secretions)
airway obstruction
vomiting
trauma, burns and face malformation.

There is high evidence-based efficacy in treatment of chronic lung disease, in cardiogenic pulmonary edema, immunocompromised patients, difficult weaning from ventilator and restrictive lung pathology.

There is moderate evidence-based efficacy in cystic fibrosis, asthma, postoperative respiratory failure and "do not intubate" patients. Extubation failure, ARDS and pneumonia have shown evidence-based efficacy.

Indispensable factors resulting in NPPV efficacy:

Patient selection
Early treatment
Comfortable ventilator-patient interface
Psychological patient support
Continuous monitoring
Skilled and motivated team.

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Last updated on 01-01-2005 Vol 2 Issue 1 Art # 1

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Marraro G A.Practical Guidelines for Mechanical Ventilation.Pediatric Oncall [serial online] 2005 [cited 2005 January 1];2. Art # 1. Available from: