What is it?
Non-Invasive Ventilation (NIV) is a way of delivering support to the patient's breathing without the use of a breathing tube (endotracheal tube) like in mechanical ventilation. Extra support can be delivered by a mechanical ventilator, or by a special machine specifically designed for this type of therapy. Extra support is delivered through the machine, attached tubing, and then to the patient through different types of masks (see picture).
This therapy relies on the patient being awake and able to breathe spontaneously. When they take a breath in, the NIV machine delivers positive pressure and supports that breath. It also prevents that breath from exhaling completely. All these techniques will make it easier to breath.
It can be used short term and long term. Short term use is usually for those patients who are experiencing an acute episode of breathing difficulties, and is usually administered over a period of days. Long term use is for specific disease processes such as patients with obstructive sleep apnoea. These types of patients will probably use it for the rest of their lives during sleep.
Why is it done?
NIV is a way of supporting a patients breathing when they are having difficulties. It is used for certain conditions such as;
- Obstructive sleep apnoea
- Pulmonary oedema
- Acute respiratory failure.
It makes breathing less difficult by;
- Increasing the size of the breath
- Decreasing the amount of work the patient has to create to take that breath
- Preventing collapse of alveoli (tiny air filled sacks at the end of the bronchial tree – this is where oxygen diffuses across into the blood stream to be used by the tissues)
- Splinting open collapsed alveoli, allowing more sites for oxygen to diffuse across into the bloodstream
- Allowing the delivery of high concentrations of Oxygen
What happens in intensive care?
Intensive care units see both acute and chronic patients. In the acute phases NIV is used to support the patients breathing until they have either improved and do not require this therapy anymore, or they may deteriorate to the point where a more invasive therapy has to be instigated, such as the insertion of an endotracheal tube (Plastic hollow tube that is inserted into the patient’s lungs). This will allow a mechanical ventilator to do all the work of breathing.
There are different types of masks that can be used to deliver NIV. Masks that cover just the nose, mouth and nose, and full facial masks that cover the whole head. Each mask has different uses. This mask is placed onto the patients face firmly to prevent air from leaking around the mask. Initially patients may feel uncomfortable, and often complain of feeling claustrophobic or suffocated. However once the treatment starts to work patients do report feeling like they can breath easier, and are more comfortable. The amount of time receiving NIV will vary from patient to patient depending on their condition and how they respond to treatment.
Of course, if you have any questions or concerns, please discuss them with the ICU nurses and doctors
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Knebel, A., Allen, M., McNemar, A. & Feigenbaum, K. (1997). A guide to non-invasive intermittent ventilatory support. Heart & Lung, 26 (4) 307-316.
Mahamid, E. (2000). Non-invasive positive-pressure ventilation in acute respiratory failure. Care of the Critically Ill, 16 (2). 55-58.
Marshall, A. & Pittard, M. Nursing the patient receiving Continuous Positive Airway Pressure Therapy. Australian Nurses Journal, Clinical Update. February 1998.
Moore, M.J. & Schmidt, G.A. (2001). Keys to effective non-invasive ventilation, Part 1: Initial steps. Journal of Critical Illness, 16 (2) 64-70.
The information contained on this page is general in nature and therefore cannot reflect individual patient variation. In addition it reflects Australian intensive care practice which may differ from other countries. It is meant as a back up to specific information which will be discussed with you by the Doctors and Nurses caring for your loved one. ICCMU attests to the accuracy of the information contained here BUT takes no responsibility for how it may apply to an individual patient. Please refer to the full disclaimer.
Non-Invasive Ventilation Version 1 (Author: Suzy Dimovski, Royal Prince Alfred Hospital, NSW, Australia)
First published August 2008
Correspondence: ICCMU CNC