Modiedin accordance with the AGNN’s 2019 treatment recommendationsfor
emergency medicine (AGNN = Arbeitsgemeinschaft in Norddeutschland tätiger
Notärzte e.V. - Working group of emergency physicians working in North Germany),
translated by WEINMANN Emergency
Logistical requirements
Oxygen supply: At least one 2-l cylinder, full................................................... Check
Emergency team familiar with NIV ................................................................. Check
Clinical requirements
Conscious, co-operative patient breathing spontaneously .............................. Check
If appropriate, administer mild sedation, e.g. morphine
(5 - 10 mg iv, fractionated) or short-acting benzodiazepine, to agitated patients
Indications
Dyspnea ......................................................................................................... Check
Respiratory rate > 25/min (count!) ................................................................. Check
SpO
2
< 90 % despite administration of O
2
...................................................... Check
Contraindications
Absolute contraindications ............................................................................. Check
No spontaneous breathing, gasping, blocked airways
gastrointestinal hemorrhage or ileus
Relative contraindications ............................................................................... Check
Coma, severe agitation, hemodynamic instability, severe
hypoxemia (SpO
2
< 75 % despite O
2
administration), problems accessing airway,
status post gastrointestinal surgery
NIV sequence: Make settings to ventilator. Commence NIV with patient
semi-seated or seated. Use mask if at all possible, putting it up to the
patient’s face slowly. The patient can hold the mask initially, if appropriate.
Connect the mask to the breathing circuit with the ventilator running.
Aim: To synchronize device and patient
SOP (Standard Operating Procedure)
Non-invasive ventilation (NIV) for emergency medical services
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