D-10 624074/07
D NIV (Noninvasive ventilation)
Maintaining PEEP and preventing autotriggering. Signifi-
cant leakage can be present in noninvasive ventilation, which
can serve to reduce the actual applied PEEP/CPAP and give rise
to autotriggering. If you cannot reach the set PEEP/CPAP, check
the mask fit.
The ventilator maintains PEEP with the expiratory valve in
combination with a compensating base flow delivered by the
inspiratory valve through the breathing circuit.
The
Loss
of
PEEP
alarm alerts you to uncompensated leaks
(that is, when the measured PEEP/CPAP is 3 cmH2O lower than
the set PEEP/CPAP).
Inspect mask fit and position. For noninvasive ventilation
to function as intended, the mask must fit well and remain
in place. It is desirable to maintain a good seal and minimize
leakage.
Inspect the mask position regularly and adjust as necessary.
If the mask slides away from the mouth and nose (patient
disconnection), reinstall and secure it. React promptly and
appropriately to any alarms.
The ventilator’s Leak parameter provides one indicator of mask
fit. To check the proper fit of the mask, verify that the patient
can trigger and flow-cycle inspiration. Verify that:
Ppeak = (PEEP/CPAP + Psupport/Pinsp) ±3 cmH2O.
CO
2
rebreathing in noninvasive ventilation.
CO
2
rebreathing per breath can increase in noninvasive ventila-
tion. Typically this is not critical, because there is also generally
significant leakage in noninvasive ventilation. CO
2
rebreathing
can occur because there is not the usual dead space reduction
from an endotracheal tube or tracheostomy, and the mask or
other noninvasive interface creates additional dead space.
Consider this additional dead space when prescribing a specific
type of noninvasive patient interface. Despite the use of a non-
invasive interface, the dead space ventilation per minute can
decrease when the therapy results in an increase in tidal vol-
ume and decrease in respiratory rate.
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