Transcript Part IV: Application of NPPV and CPAP in Specific Disorders By: Susan P.

Part IV: Application of NPPV
and CPAP in Specific Disorders
By:
Susan P. Pilbeam, MS, RRT, FAARC
John D. Hiser, MEd, RRT, FAARC
Ray Ritz, BS, RRT, FAARC
American Association for Respiratory Care
December, 2006
Outline
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Use of NPPV in patients with acute-on-chronic
respiratory failure, acute asthma
Use of NPPV in immunocompromised patients.
Use of CPAP in patients with acute congestive
heart failure without myocardial infarction
Use of NPPV in patients with do-not-intubate
directives
Use of NPPV to facilitate weaning from invasive
ventilation
Use of NPPV in patients with acute-on-chronic
respiratory failure.
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NPPV is strongly recommended for patients with
chronic COPD who are experiencing worsening
of their condition
This is true as long as the individual patient does
NOT have any exclusionary criteria (See Part II)
Numerous studies support the use of NPPV in
this patient group
Use of NPPV in patients with acute-onchronic respiratory failure.
In this patient group, NPPV can result in:
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Reduced need for intubation
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Reduced in-hospital mortality
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Reduced length of stay
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Results in fewer complications associated with
an artificial airway and invasive ventilation
(example, ventilator associated pneumonia)
NPPV in Acute Asthma
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More studies are needed to to determine if NPPV
is an effective treatment for patients with acute
asthma
Available studies suggest that NPPV in this
patient group may improve oxygenation and
ventilation
Intubation rate may also be reduced in this
group
Immunocompromised Patients
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Immunocompromised patients are at increased
risk of infection
This patient group can benefit from NPPV
because it helps avoid intubation
Airway damage during intubation and the risk of
ventilator associated pneumonia are two
problems that are avoided if NPPV can be used
Immunocompromised Patients
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In immunocompromised patients with moderate
to severe respiratory distress, NPPV may be
used if no other contraindications (exclusionary
criteria) exist
Use of NPPV or CPAP in patients with acute
congestive heart failure
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In patients with acute cardiogenic pulmonary
edema, NPPV reduces the intubation rate
It also reduces the mortality rate.
Evidence is good that either CPAP by mask or
NPPV improves clinical outcomes in this patient
group1
Use of NPPV in Patients with Do-NotIntubate Directives
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Use of NPPV in patients with “do-not-intubate”
directives is controversial
These patients typically have irreversible and
terminal disease
Patients must understand NPPV cannot cure
them
NPPV is a form of life support and may provide
relief of symptoms of respiratory distress
NPPV to Facilitate Weaning
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In patients with chronic respiratory failure who
are invasively ventilated, NPPV may facilitate
weaning
In this patient group, NPPV, compared to
invasive PSV, reduced the following:
 Weaning time
 Length of stay in ICU
 Nosocomial pneumonia
 60-day mortality rate
NPPV to Facilitate Weaning
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In patients with COPD who are difficult to wean
from invasive ventilation, caution must be used
The patient must be willing to cooperate.
The patient must be able to maintain their
airway without risk of aspiration
The patient must be able to clear secretions
Section Summary
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NPPV has been shown to be beneficial to the
following patient groups
 Acute-on-chronic respiratory failure
(e.g. exascerbation of COPD)
 Patients with acute asthma
 Acute congestive heart failure (not caused by
an acute myocardial infarction)
 Patients who are immunocompromised
 To facilitate weaning from invasive ventilation
in difficult to wean patients with COPD