challenges in critical care: geisinger medical center - Maquet

| 6 | Geisinger Hospital | Critical Care |
Guidelines:
NPPV (Non-Invasive Positive Pressure Ventilation)
1. Initiation of NPPV
a. In conjunction with section B:
Patient Assessment, a spontaneously breathing patient
with two of the following criteria may be a candidate
for NPPV:
1. dyspnea
2. accessory muscle use
3. SaO < 90%
4. respiratory rate > 24 BPM
b. A patient with the following is not a candidate for NPPV:
1. respiratory arrest
2. uncontrolled arrhythmia
3. airway obstruction
4. inability to clear secretions
5. coma, uncooperative or claustrophobia
6. facial trauma
7. hypotension with systolic blood pressure
< 90 mmHg
c. Initial settings include:
1. NIV-Pressure Support
2. Pressure Support Level = 10cmh20
3. PEEP = 4 cmh20
4. backup rate=8 BPM
5. inspiratory rise adjusted to patient comfort.
Note: A comfortable, properly fitting mask should be chosen, too.
d. To adjust for optimal ventilation, increase PS in increments
of 2 cm H2O to relieve respiratory distress, and to adjust for
inadequate oxygenation, increase PEEP (in increments of 2 cm
H2O) and/or FiO to achieve SaO > 92%. Note: Increases in PEEP
will decrease PS. Therefore, PS may have to be increased to
maintain desired ventilation.
2. Discontinuation of NPPV
a. When precipitating cause(s) of respiratory failure is/are sufficiently resolved, when minimal NIV support (PS and PEEP) pressures are
needed to maintain adequate patient comfort without signs/symptoms of respiratory distress, and when FiO < 65%, a trial off NPPV
can be initiated. Note: Minimal NIV support pressures are: PS = 10 cm H2O and PEEP=4 cm H2O. The views, opinions, and assertions stated by Geisinger Medical
Center staff members in this article are strictly those of the
clinicians and administrators, and do not necessarily reflect the
views of MAQUET.