Benefits of NIPPV – High-flow Oxygen Delivery (Nursing)

00:00 Okay, we've talked a lot about positive pressure ventilation. Now I want to consider that you're making a case. Let's pretend that you're a lawyer and you're going to give me your 7 main points on why noninvasive positive pressure ventilation is a good thing. Well first of all, it has a lower mortality rate. Cool. We've got the fancy statistics there for you to look at.

00:23 You have less need for endotracheal intubation, another good thing. Because endotracheal intubation comes with this own risk for infection et cetera. Now you have a lower rate of treatment failure. Cool. Because you can't really deliver some cool oxygenation stuff with positive pressure ventilation, you're overcoming some of the things in the patient's respiratory tract. So you'll see a greater improvement in the 1 hour post-treatment pH and PaCO₂. So what? No, that's really cool. Because once you start somebody on NIPPV then at the 1-hour mark we're going to compare those ABGs to the ones that you took before treatment. If we see an improvement in the pH, that means you're likely moving them from respiratory acidosis toward the normal pH. We see an improvement in the PaCO₂ then that means those levels are going to be going down because likely they were elevated. If it was respiratory acidosis, they have to be elevated above normal. Now that we have them breathing more efficiently, those PaCO₂ levels are going to be closer to normal. so you have a lower respiratory rate. Because we're helping the patient breathe with this positive pressure ventilation, the respiratory rate should be lower than it was before. That means they are going to stay in the hospital a shorter length of time. That's a win for everybody. The longer in the hospital, the longer you're exposed to things, it's just not the best for the patient. We want them only there as long as they need our services, our goal is to get them discharged back to their normal environments.

02:04 And lastly, we talked about the risk of intubation, but let's break those down a little bit. When someone's intubated and on a mechanical ventilator, they can really develop some nasty infections. One is called VAP, a ventilator-associated pneumonia. Now that's a term you sadly need to be familiar with as a healthcare provider. Ventilator-associated pneumonias come in risk of complications from intubation. We have to do things like really good oral care and be right on top of things because their immune systems are compromised so if we can avoid invasive, we're going to minimize the risk of infection. They could also have problem with tracheal stenosis if someone has that going on from the intubation. So it's better to avoid intubation if we can. Now, how do you know when what we're trying to avoid it's necessary? Why would we have to intubate a patient? Well, we've tried on the oxygen delivery methods, we ended up on BiPAP, but how do we know when BiPAP is just not doing it, it's not cutting the mustard as we say. Well the maximum IPAP, inspiratory positive airway pressure, is 20-30 cm of water, depends on the machine. You'll have to work it out with your healthcare provider and the individual specific machine and what's going on with the patient. But if BiPAP is going to work and be successful, it should be obvious after 20-40 minutes being on the BiPAP. So if it's longer than 40 minutes and the patient just isn't making an improvement, then you really going to have to consider endotracheal intubation. So when talking about CPAP versus BiPAP, this is that summary slide we looked at before. So what I want you to do is I don't want to talk you through it this time again, I want you to pause the video and you teach that to some pretend students that are in your study room with you now.