Justine has been a Registered Nurse for 10 years and has a Bachelor's of Science in Nursing degree.
What Is NPPV?
Sally is a nurse who works in the critical care unit of her hospital. It's not unusual to care for patients who are in acute or chronic respiratory failure. These are patients with COPD, asthma, pneumonia, or heart failure.
Non-invasive positive pressure ventilation (NPPV) is often used to help these patients breathe more comfortably. It is less invasive compared to endotracheal intubation to assist with ventilation. It also allows patients to maintain normal functions such as coughing, swallowing, eating, and speaking. Since it's not invasive, it decreases the likelihood of developing a respiratory infection compared to intubation. NPPV can also be used in the home setting.
Through the use of positive pressure, it promotes the alveoli in the lungs to remain open and avoid collapse. Patients who are appropriate candidates for NPPV have moderate respiratory failure. It is not appropriate for very mild respiratory issues or very severe. The patient should be cooperative and will have symptoms of dyspnea, tachypnea, and hypoxemia.
NPPV Delivery Systems
Sally is attending an in-service at her hospital to learn more about the different delivery systems for NPPV. A high-flow nasal cannula is the least invasive device to provide respiratory support that is easily tolerated by patients. It consists of a system to heat and humidify the oxygen that is being delivered to the patient, which allows for better tolerance of the high flow of oxygen. Oxygen can be delivered at up to 60 liters per minute. High-flow nasal cannulas do not augment the tidal volume, which is the volume of air breathed in and out.
A venturi mask is another option. This is a mask with a flexible tube that is connected to oxygen. This mask controls how much room air oxygen is breathed in and, therefore, can provide high levels of oxygen. The venturi mask can provide 24-60% of FiO2, which is the fraction or percentage of oxygen being administered. For comparison, room air FiO2 is approximately 21%.
A non-rebreather mask is a mask with an attached reservoir that can administer an FiO2 of 85-90%. It requires oxygen flow of 15 liters per minute for the mask to correctly work.
Depending on the patient's extent of respiratory failure and oxygen needs, the nurse can choose between these three options to meet their needs. There are also mechanical non-invasive positive pressure delivery systems.
Mechanical Delivery Systems
Continuous positive airway pressure (CPAP) is a continuous positive pressure of oxygen flow, and the patient is able to spontaneously breathe. This consists of a tight-fitting mask that needs to have a good seal to work effectively. CPAP is commonly used for sleep apnea and for patients with respiratory distress from pulmonary edema.
Bilevel positive airway pressure (BiPAP) provides positive pressure that is greater on inspiration than on exhalation. BiPAP senses the patient's breathing and adjusts the pressures according to the settings. BiPAP increases the tidal volume and improves ventilation. It decreases CO2 levels and reduces the work of breathing. BiPAP is often used for COPD exacerbations.
Nursing Management of NPPV
Sally wants to know her responsibility in caring for patients with different types of non-invasive positive pressure oxygen delivery systems. The nurse should regularly assess how the patient is tolerating the device. Assessment of respiratory status including oxygen saturation, respiratory rate and effort, cough, and secretions should be done. The different devices can cause skin irritation, so close monitoring of the patient's skin and appropriate fitting of the device is important.
Patients may have irritation to their eyes, ears, or sinuses from the devices. They may also develop gastric distention from the positive pressure of the air. All of these need to be closely monitored as well. Patients may need to be sedated to help them tolerate the oxygen delivery device, and if so, the nurse will administer appropriate medications and closely monitor levels of sedation.
Non-invasive positive pressure ventilation (NPPV) can be an option for patients in respiratory distress while avoiding invasive intubation and mechanical ventilation. Patients in acute or chronic respiratory failure such as pneumonia, COPD, asthma, or heart failure may benefit from NPPV.
High-flow nasal cannulas heat and humidify oxygen and can deliver up to 60 liters per minute. This is generally well tolerated but doesn't increase tidal volume of respiration. A venturi mask can provide 24-60% FiO2. A non-rebreather mask provides an even higher percentage of FiO2 at 85-90%. The patient's oxygen requirements will determine which of these should be used.
Mechanical non-invasive positive pressure ventilation is another option. Continuous positive airway pressure (CPAP) is often used for sleep apnea and for pulmonary edema. Bilevel positive airway pressure (BiPAP) provides a higher pressure with inhalation and slightly lower pressure with exhalation. With CPAP, the patient can breathe with continuous pressure, whereas in BiPAP, the machine senses the patient's breathing and adjusts pressure.
Nurses should monitor how the patient is tolerating the oxygen delivery device and respiratory status regularly. They should assess for eye, ear, or nasal irritation as well as gastric distention. Skin irritation can also occur from the devices. Some patients may require sedation to tolerate the non-invasive positive pressure delivery system.
Medical Disclaimer: The information on this site is for your information only and is not a substitute for professional medical advice.
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