NIV in

the ICU

With its monitoring facilities, 24 hour staff availability, and trained care givers, the intensive care unit (ICU) provides the setting for successful NIV. In the ICU, there is much interest in NIV to prevent intubation and ventilator-associated pneumonia.

 

Most study settings around the benefits of NIV have been performed on the ICU or a high acuity setting. The ICU with its monitoring capabilities, 24 hour staff availability, trained care givers as well as the possibility for quick intubation in case of NIV failure offer without any doubt a good setting for successful NIV.

 

Some hospitals report using more NIV than invasive ventilation in acute respiratory failure (ARF) leading them to rethink the optimal utilization of the ICU. Other hospitals worldwide are reporting that their ICU’s are chronically full and with increased pressure to move patients out of the emergency department, many hospitals actively seek alternate areas to perform NIV in certain categories of ARF.

 

A general concern when it comes to NIV either inside or outside the ICU is the additional workload which has been suggested in early studies. The International Consensus states that NIV therapy doesn’t appear to increase nursing or respiratory therapist workload.¹

 

It is relevant to note that staff training and experience is more important than the actual location where NIV is being performed in the hospital as stated by Elliott et al.²

 

One major challenge in the ICU is VAP (ventilator-associated pneumonia). Between 10 and 20 percent of patients receiving >48 hours of mechanical ventilation will develop VAP.Patients who have developed VAP are twice as likely to die compared to similar patients without VAP and as a result have significantly longer stays in the ICU.³

 

Therefore, there is much interest in avoiding intubation and using NIV treatment instead. Strong evidence suggests that patients who are appropriate candidates for NPPV can benefit from such treatment by showing lower rates of pneumonia infections, intubations and also mortality.

 

Read more about how NIV can help to prevent intubation here.

 

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Contraindications to non invasive ventilation

Absolute contraindications

 

  • Cardiac or respiratory arrest
  • Non-respiratory organ failure (i.e, GI bleeding, hemodynamic instability..)
  • Upper airways obstruction
  • Need to protect the airways
  • Instability to clear secretion
  • Facial surgery or trauma

 

Relative contraindications

 

  • Coma and severe sensorium impairment
  • Agitation or diaphoresis
  • Severe hypoxia (i.e. PaO2/FiO2< 100)
  • Very limited spontaneous breathing

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Sources

 

1: International Consensus Conferences in Intensive Care Medicine: Noninvasive Positive Pressure Ventilation in Acute Respiratory Failure. American Journal of Respiratory and Critical Care Medicine, Vol. 163, No. 1 (2001), 283-291

 

2: Elliott, MW., Confalonieri, M., Nava, S. Where to perform noninvasive ventilation?. Eur Respir J, 2002; 19: 1159–1166

 

3: Safdar, N., Dezfulian, C., Collard, HR., Saint, S. Clinical and economic consequences of ventilator-associated pneumonia: A systematic review. Crit Care Med 2005 Vol. 33, No. 10: 2184-2193

 

4: Hess D. Noninvasive positive-pressure ventilation and ventilator-associated pneumonia. Respir Care. 2005;50(7): 924-929

 

5: Evans TW. International Consensus Conferences in Intensive Care Medicine: Non-invasive positive pressure ventilation in acute respiratory failure. Intensive Care med. (2001):27: 166-178

 

6: Scala R., Naldi M., Nava S. Non-invasive positive pressure ventilation in COPD patients with acute hypercapnic respiratory failure and altered level of consciousness. Chest (2005): 128: 1657-1666

 

7: Constantin, JM., Schneider, E., Cayot-Constantin, S., et al. Remifentanil-based sedation to treat non-invasive ventilation as a first-line intervention for acute respiratory distress syndrome. Crit Care Med (2007): 35: 18-25

 

8: Antonelli, M., Conti, G., Esquinas, A., et al: A multiple-center survey on the use in clinical practice of noninvasive ventilation as a first-line intervention for acute respiratory distress syndrome. Crit Care Med (2007): 35: 18-25

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thinkNIV

 

Despite its proven benefits to improve patient comfort and reduce mortality and also costs, noninvasive ventilation (NIV) is still underutilized at many hospitals. This website is designed to promote the usage of NIV by sharing the many situations in which NIV improves patients’ outcomes as well as to inform about the factors which are important in order to perform successful NIV.

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