Noninvasive ventilation and high-flow oxygen therapy: Succeed in respiratory care

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It can be a challenge to keep up with the latest innovations in hospital ventilation systems and techniques, and the many ways they are changing the management of patients with respiratory failure. Staying up to date on emerging applications, including noninvasive ventilation (NIV) and high-flow therapy, is important given how many patients are ventilated during a hospital stay and the importance of weaning to reduce complications from continued breathing assistance.

50%+ of ICU patients are intubated within 24 hours of admission¹

310 per 100,000 U.S. adults undergo invasive ventilation for nonsurgical indications²

40% of the total duration of mechanical ventilation is the weaning process³

NIV and high-flow nasal cannula: emerging applications

It’s no exaggeration to say that NIV has revolutionized the treatment of acute respiratory failure.⁴ And recently, high-flow nasal cannula (HFNC) oxygen delivery has gained popularity as part of a strategy for supportive therapy in many clinical situations, including weaning.

Learn what experts are saying about these modalities.

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NIV vs HFT Quiz

Which therapy would you use for a chronic obstructive pulmonary disease patient with exacerbation ? Or when treating a hypoxemic or cardiogenic pulmonary edema patient? Test your knowledge about which treatment is recommended for these conditions and others.

NIV vs HFT Quiz

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Which therapy would you use for a COPD patient with exacerbration?

NIV

HFT

Both

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NIV vs HFT Quiz

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Which therapy would you use for a COPD patient with community-acquired pneumonia?

NIV

HFT

Both

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NIV vs HFT Quiz

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Which therapy would you use for a Immunocompromised patient?

NIV

HFT

Both

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NIV vs HFT Quiz

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Which therapy would you use when treating a hypoxemic?

NIV

HFT

Both

NIV vs HFT Quiz

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NIV vs HFT Quiz

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Which therapy would you use when managing a cardiogenic pulmonary edema patient?

NIV

HFT

Both

NIV vs HFT Quiz

Answer

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NIV vs HFT Quiz

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Which therapy would you use when treating a post-extubation patient?

NIV

HFT

Both

NIV vs HFT Quiz

Answer

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NIV vs HFT Quiz

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Which therapy would you use when managing a postoperative abdominal patient?

NIV

HFT

Both

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Why NIV over invasive ventilation?

Clinicians understand that while invasive ventilation can be lifesaving, the risk of potential complications – like infections and injury to the lungs and other organs – runs high. That’s why NIV has become a widely used therapy option and is now considered the mode of choice for some conditions.

NIV has also been associated with reduced length of hospital stay and reduces mortality, patient discomfort and length of-stay for exacerbations of COPD compared to standard therapy.⁵

Advantages of NIV over invasive ventilation

Application

Avoid intubation
Patient discomfort
Upper airway trauma

Minimize ventilator acquired pneumonia⁶

Intubation is associated with GI bleeding
Less chance of barotrauma

Decreases work of breathing

Improves alveolar ventilation
Improves gas exchange
Counterbalances intrinsic PEEP

Oral patency

Preserves efficiency of cough and secretion clearance
Allow speech, allowing the patient to communicate
Preserves ability to swallow
Reduces need for NG tube

Transitioning to NIV?

Here are some tips:

Set realistic expectations – NIV does not avoid intubation in all cases – a NIV failure rate of 20-40% is expected based on current clinical evidence.⁷

Experience matters – Only practice of NIV will lead to the needed experience to perform successful NIV.

Noninvasive ventilation is one of those rare medical technologies that both improves patient outcomes and reduces treatment costs.”

– Adam Seiver, MD, PhD, MBA, Chief of Medical Affairs, Philips Monitoring and Analytics & Therapeutic Care

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Avoid NIV complications

Complications with NIV can be pressure-related

Complication	Remedy⁸
Nasal congestion	Try humidification or speak to the physician for various remedies to assist with this problem
Nasal or oral dryness	Add humidification, nasal saline, oral/nasal hygiene, or decrease leak
Sinus or ear pain	Lower inspiratory pressure
Gastric inflation	Avoid excessive inspiratory pressures (over 20 cmH₂O)
Eye irritation	Check mask fit, readjust bottom headgear straps, and be aware of air leaks near eyes
Failure to ventilate	Use sufficient pressures, optimize patient-ventilator synchrony

Complication

Nasal congestion

Remedy⁸

Try humidification or speak to the physician for various remedies to assist with this problem

Nasal or oral dryness

Try humidification or speak to the physician for various remedies to assist with this problem

Sinus or ear pain

Lower inspiratory pressure

Gastric inflation

Avoid excessive inspiratory pressures (over 20 cmH₂O)

Eye irritation

Check mask fit, readjust bottom headgear straps, and be aware of air leaks near eyes

Failure to ventilate

Use sufficient pressures, optimize patient-ventilator synchrony

Complication

Nasal congestion

Remedy⁸

Try humidification or speak to the physician for various remedies to assist with this problem

Complication

Nasal or oral dryness

Remedy⁸

Try humidification or speak to the physician for various remedies to assist with this problem

Complication

Sinus or ear pain

Remedy⁸

Lower inspiratory pressure

Complication

Gastric inflation

Remedy⁸

Avoid excessive inspiratory pressures (over 20 cmH₂O)

Complication

Eye irritation

Remedy⁸

Check mask fit, readjust bottom headgear straps, and be aware of air leaks near eyes

Complication

Failure to ventilate

Remedy⁸

Use sufficient pressures, optimize patient-ventilator synchrony

Complications can also be mask-related

Complication	Remedy⁸
Discomfort	Check fit, adjust straps, or change the mask
Nasal or oral dryness	Add humidification, nasal saline, oral/nasal hygiene and manage leak by decreasing the amount of leak
Nasal bridge redness or ulceration	Use an artificial skin, minimize strap tension, use LiquiCell, alternate masks or use a PerforMax or Total face mask
Skin irritation or rashes	Use a skin barrier lotion and/or topical corticosteroids, change to a mask made from a different material, be sure to properly clean the mask
Claustrophobic reactions	Try a nasal mask or PerforMax or Total face mask; sedate judiciously

Complications can also be mask-related

Complication

Remedy⁸

Discomfort

Check fit, adjust straps, or change the mask

Nasal or oral dryness

Add humidification, nasal saline, oral/nasal hygiene and manage leak by decreasing the amount of leak

Nasal bridge redness or ulceration

Use an artificial skin, minimize strap tension, use LiquiCell, alternate masks or use a PerforMax or Total face mask

Skin irritation or rashes

Use a skin barrier lotion and/or topical corticosteroids, change to a mask made from a different material, be sure to properly clean the mask

Claustrophobic reactions

Check mask fit, readjust bottom headgear straps, and be aware of air leaks near eyes

Complications can also be mask-related

Complication

Discomfort

Remedy⁸

Check fit, adjust straps, or change the mask

Complication

Nasal or oral dryness

Remedy⁸

Add humidification, nasal saline, oral/nasal hygiene and manage leak by decreasing the amount of leak

Complication

Nasal bridge redness or ulceration

Remedy⁸

Use an artificial skin, minimize strap tension, use LiquiCell, alternate masks or use a PerforMax or Total face mask

Complication

Skin irritation or rashes

Remedy⁸

Use a skin barrier lotion and/or topical corticosteroids, change to a mask made from a different material, be sure to properly clean the mask

Complication

Claustrophobic reactions

Remedy⁸

Check mask fit, readjust bottom headgear straps, and be aware of air leaks near eyes

Did you know?

37.5% of patients fail NIV because of mask intolerance and discomfort, a reason recognized as one of the most common for NIV failure.This is because the mask was not fitted properly or it’s the wrong type of mask for the patient.⁹

Education and resources

Explore webinars, courses and videos for practice guidelines and ways to enhance your hospital ventilation program’s success.

Optimal respiratory care requires optimal technique

High-flow oxygen therapy, noninvasive ventilation and invasive mechanical ventilation: Learn more about optimal respiratory techniques for optimal care.

Learn more

Skin integrity training

LeBonheur Children’s Hospital and Philips team up to bolster staff education through Philips Saving Face NIV mask rotation training program.

Watch the video

HFNC and NIV current and practice

This presentation reviews evidence in support of NIV and discusses the research evaluating HFNC and its role in the management of respiratory failure.

Watch the webinar

References

1. According to the American Association for the Surgery of Trauma (AAST).

2. Mehta AB, Syeda SN, Wiener RS, Walkey AJ. Epidemiological trends in invasive mechanical ventilation in the United States: a population-based study. J Crit Care. 2015;30(6): 1217-1221.

3. McConville JF, Kress JP. Weaning patients from the ventilator. N Engl J Med. 2012;367(23):2233-2239.

4. Scott K. Epstein, MD, Respiratory Care, January 2009 Vol 54 No 1.

5. Keenan SP, Gregor J, Sibbald WJ, Cook D, Gafni A. Noninvasive positive pressure ventilation in the setting of severe, acute exacerbations of chronic obstructive pulmonary disease: more effective and less expensive. Crit Care Med. 2000 Jun;28(6): 2094-102.

6. Respiratory Care, Feb 2009 54(2):198-211)

7. Hess D. How to Initiate a Noninvasive Ventilation Program: Bringing the Evidence to the Bedside. Respiratory Care (2009), Vol 54 NO 2: p. 232-245.

8. Nava, S., et al. Interfaces and Humidification for Noninvasive Mechanical Ventilation. Resp. Care. Jan 2009. Vol 54-1.

9. Squadrone E, et al. Noninvasive vs invasive ventilation in COPD patients with severe acute respiratory failure deemed to require ventilatory assistance. Inten Care Med. 2004;30(7).

Philips is not a medical care provider, and this information is not intended to diagnose, examine treat or manage medical conditions of any kind. The content on this page is not a substitute for professional judgment by a healthcare provider.

Hospital ventilation: devoted to success

Noninvasive ventilation and high-flow oxygen therapy: Succeed in respiratory care

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Contact information

NIV and high-flow nasal cannula: emerging applications

NIV vs HFT Quiz

NIV vs HFT Quiz

Which therapy would you use for a COPD patient with exacerbration?

NIV vs HFT Quiz

Answer

NIV vs HFT Quiz

Which therapy would you use for a COPD patient with community-acquired pneumonia?

NIV vs HFT Quiz

Answer

NIV vs HFT Quiz

Which therapy would you use for a Immunocompromised patient?

NIV vs HFT Quiz

Answer

NIV vs HFT Quiz

Which therapy would you use when treating a hypoxemic?

NIV vs HFT Quiz

Answer

NIV vs HFT Quiz

Which therapy would you use when managing a cardiogenic pulmonary edema patient?

NIV vs HFT Quiz

Answer

NIV vs HFT Quiz

Which therapy would you use when treating a post-extubation patient?

NIV vs HFT Quiz

Answer

NIV vs HFT Quiz

Which therapy would you use when managing a postoperative abdominal patient?

NIV vs HFT Quiz

Answer

NIV vs HFT Quiz

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Why NIV over invasive ventilation?

Avoid NIV complications

Hospital respiratory ventilators – the right care at the right time

Hospital ventilation masks – flexibility and ease, for you and your patients

Education and resources