NON CONVENTIONAL VENTILATION MODES - rm solutions

NON CONVENTIONAL VENTILATION 

MODES 

MAY CHEHAB, MD, ABP, FRCP (Lon), FRCP(Edin) 

Director of Pediatric Intensive Care Unit 

Deputy Director of Pediatrics 

RIYADH MILITARY HOSPITAL

NON CONVENTIONAL MV


Non Conventional MV 

Non Invasive Ventilation NIV

Non Conventional MV 


NON CONVENTIONAL MV 



nCPAP


nPPV


BiPAP


nPPV


nPPV


NIV


NIV


NIV



NON CONVENTIONAL MV in CARDIAC PATIENTS 

Non Invasive Mechanical Ventilation

NON CONVENTIONAL MV in CARDIAC PATIENTS 



�29 articles with 2,279 patients 

�ABG improved in 15 of 22 prophylactic studies 

�ABG improved in 4 of 7 therapeutic studies, 

�Reduced intubation rate in 11 of the 29 studies 

�Improved outcome in only 1 

�NIV as prophylactic and therapeutic tool postop 

�Need for more RCT




�116 Episodes of pneumonia, bronchiolitis, asthma 

�NIV is useful in children with ARF 

� Independent risk factors for NIV failure 

�Type 1 respiratory failure(pneumonia) 

�High PRISM score at admission 

�Slow RR decrease after 1 h of NIV

NIV and Intubation Rate 

�Retrospective study, severe bronchiolitis, PICU 

�First winter epidemic: Invasive ventilation, 53 patients 

�Second winter epidemic: nPPV period, 27 patients 

In nPPV winter compared with invasive ventilation winter 

�Significantly lower rate of intubation 

�Significantly lower rate of VAP 

�LOS and duration of ventilation were similar

NIV and Intubation Rate 

�Prospective, randomized controlled study 

�50 children with ARF, pneumonia and bronchiolitis 

�nPPV by facial mask or standard medical therapy 

nPPV 

�Decreased RR and HR within 1 h 

�Decreased tracheal intubation by 47% 

�Higher intubation rate in youngest patients

NIV 

�Single-center, prospective, randomized, study: 

�nCPAP with and without heliox 

�12 infants with severe bronchiolitis 

�nCPAP improved gas exchange and respiratory pattern 

�These positive effects were enhanced when heliox 

was used in place of an air–oxygen mixture

NIV 

�NIPPV with upper airway obstruction: 

�Safe and effective 

�Avoid prolonged invasive ventilation 

�Avoid tracheostomy 

�Stabilize the airway after extubation 

�Help in obstructive sleep apnea

NIV 

�NPPV in patients suffering from status asthmaticus, 

despite some interesting and very promising 

preliminary results, still remains controversial 

�Large, prospective, randomised controlled trials 

to determine the role of NPPV in status asthmaticus

NIV 

�NIV together with standard medical therapy: 

�Could accelerate improvement in lung function 

�Decreases inhaled bronchodilator Rx 

�Shortens ICU and hospital stay 

�A larger study is required

NIV and immunocompromised oncologic children 

�Retrospective cohort study 

�239 patient with malignancy and ARF 

�nPPV reduced need for endotracheal intubation 

�Hemodynamic impairment as an independent factor 

�nPPV should be used as first-line treatment

NIV and immunocompromised oncologic children 

�NPPV is effective 

�Intubation was avoided in more than 50% of children 

�An early improvement in PaO2:FiO2 ratio was able to 

predict nPPV success


�17 RCT with 938 patients 

�CPAP and NPPV decrease mortality 

and need for endotracheal intubation 

�Neither CPAP nor NPPV increases the risk 

of AMI compared with Standard medical therapy 

Critical Care. 2006;10(2) 

Cochrane Data Base , April 2010


IDEAL VENTILATOR 

2007 

Neurally Adjusted Ventilatory Assist ventilation 

NAVA was regulatory approved for use in all age groups 

�Allows the patient to: 

�Initiate THE BREATH 

�Design THE BREATH 

�Terminate THE BREATH 

NAVA


NAVA Ventilation 

�Patient initiated breathing mode 

�Breathing support is triggered by electrical activity of 

diaphragm (Edi) ) 

�NAVA delivers ventilatory assistance: 

�Proportionate and synchronized to patient’s Edi 

(the electrical activity of the diaphragm)

Phrenic nerves 

Inflow of Air 

Impulse by Brain Respiratory Center 

egative Alveolar Pressure 

NAVA ventilation 

Spontaneous Breath 

Diaphragm Excitation 

Diaphragm Contraction 

Exciting Signal to Diaphragm 

�Proportional to integrated output of brain 

�Controls the depth and cycling of the breath


IDEAL MECHANICAL VENTILATION


IDEAL VENTILATOR



Application Of NAVA In Infants Who Underwent 

Cardiac Surgery For Congenital Heart Disease 

Zhonqqo Dana Dai Er Ke Za Zhi 2009 Jun;11(6)


Application Of NAVA In Infants Who Underwent 

Cardiac Surgery For Congenital Heart Disease 

Zhonqqo Dana Dai Er Ke Za Zhi 2009 Jun;11(6)


NAVA In Children: An Observational Study 

Pediatr Crit Care Med 2010; 11:253–257


NAVA In patients recovering spontaneous 

breathing after ARDS. Physiologic evaluation 

Crit Care Med. 2010 Sep;38(9):183


Take Home Message 

NIV


Take Home Message 

NIV


NAVA In Children: An Observational Study 

Pediatr Crit Care Med 2010; 11:253–257

NON CONVENTIONAL VENTILATION MODES - rm solutions

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