Introduction

If find myself reaching more and more for the non-invasive ventilation, in the COPD patient. I’ve always loved it for acute pulmonary oedema. However, there is something about assisting the patient’s work of breathing, that allows me to ‘titrate’ what I give.

A Case

The ambulance bring a patient in on a rebreather. She is elderly and has been unwell for the last few days.

Her respiratory rate is 32, heart rate is 125 and sats are 90%. She is afebrile and examination is normal apart for a few creeps in both bases.

A set of gases reveals the following:

pH 7.3
PaO2 63
PaCO2 37
HCO3 20
SaO2 90%

Does she meet Criteria for Non-Invasive Ventilation? Yes she does?

What type of Non-Invasive Ventilation would you use; CPAP or BiPAP?

What type of NonInvasive Ventilation would you use for:
(A) Acute Pulmonary Oedema?
(b) COPD?
(c) Asthma?
…. and why   … all answers in the 9 minute video below:

You place the patient on BiPAP (settings EPAP 6 / IPAP 11) and wean down to 50% and the patients gases improve markedly:

paO2 137
paCO2 39

The patients respiratory rate is still high at 28 breaths  per minute.
What setting would you change on the machine to assist the patient? This is all about work of breathing, so increase the IPAP, whist keeping EPAP constant.

Answers in the 9 minute video below as well as an explanation of how Non-Invasive Ventilation works. (If the video doesn’t play, just click this link)

 

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