Patent airway/secretion clearing/NGT(decompress stomach)

Minimal monitoring

• Saturation probe
• ABG/arterial line
• Critical care environment

Settings

CPAP

BiPAP

• IPAP 10-20 (increase in 5cm increments)
• EPAP 5

BiPAP - inspired oxygen unknown due to complex interaction between gas mixing, site of O2 addition and leakage
CPAP - constant oxygen flow driven

CPAP - Continous Positive Airways Pressure

1. Closed circuit to provide positive airways pressure throught all phases of respiratory cycle
2. Attached to Tight-fitting mask / ETT
3. Effects
   • Recruitment of collapsed alveoli (prevents collapse at expiration)
   • Increased FRC (increases volume), improves lung compliance; reduces work of breathing
   • Improves oxygenation
4. Risks:
   • Uncomfortable
   • Gastric dilation
   • Barotrauma to alveoli due to high pressures

Predictors of NIV success

Young age
Lower acuity of illness (APACHE score)
Able to co-operate: better neurological score
Able to co-ordinate breathing with ventilator
Less air leak, intact dentition
Improved gas exchange

Adjunct treatments

• Antibiotics
• Humidification / saline +/- bronchodilating nebules
• Steroids?