Noninvasive Positive Pressure Ventilation (NIPPV) – High-flow Oxygen Delivery (Nursing)

00:00 Now we use these terms a lot; noninvasive, invasive. What is the difference? Well you see in the one picture that someone has a mask, a healthcare provider has an ambu bag, they'll squeeze that down, that would deliver volumes of breath through that mask. That mask has kind of a cushion all the way around it so you notice that the healthcare provider's applying direct pressure on that. So while it's not comfortable for an alert patient, when you're doing this on a patient it's noninvasive. Everything is external to the body. Invasive would be an example of an intubated patient. That's who you see connected to a ventilator. Look how that tube enters the body through the oral cavity, the tube goes into the trachea or the windpipe and it's attached to a ventilator. Now you can't see the ventilator that it's connected to in that picture, but if you follow that tubing all around it would lead to a ventilator. Noninvasive, everything is external to the patient's body. Invasive, would be an example of when it enters the patient's body like in intubation. So, noninvasive ventilation is often used, it's a pretty popular method for adult respiratory management both in the ER. Now remember you can see emergency department, emergency room, trauma emergency center. Those are all references to the same type of care, but it can also be used in the intensive care and it's increasingly used in the care of pediatric patients. It just makes sense why most people would want noninvasive ventilation over invasive ventilation. But let's break it down a little more.

01:38 Noninvasive, positive pressure ventilation includes both CPAP and BiPAP. Now, the C in CPAP stands for continuous. So that's continuous positive airway pressures. I always say that's like slapping a hair dryer on your face because it's one constant consistent continuous pressure.

01:59 These are commonly used for people who have obstructive sleep apnea. Now obstructive sleep apnea is usually recognized by when someone who is with the patient when they sleep noticed they have periods of apnea and super loud snoring. That's that airway when they get relaxed, it obstructs or closes and that's what makes that large amount of noise when they snore. So, by taking continuous positive airway pressure, that will help keep that airway open.

02:33 That will resolve the obstructed airway that comes when they relax. It's that high pressure air and sometimes oxygen and they have to wear a tight-fitting mask. I have some friends that have to wear this at night and boy nothing makes a girl feel prettier when you have to strap one of these on before you go to sleep. But it makes a big difference. We know that obstructive sleep apnea has some nasty side effects if it goes untreated. It changes the pressures in your thoracic cavity if you don't have it treated, could affect your cardiac output and your heart function. So it's a serious problem. Besides the people around you, it's pretty noisy, keeps them awake, it definitely has some ongoing health issues. So if you or someone you know has obstructive sleep apnea, they really do need to seek treatment. So this positive pressure all the time is what helps keep those airways open. We can also use it in acute pulmonary edema and sleep apnea. So, that's kind of where we might choose to use CPAP. Now BiPAP is kind of like the deluxe model. It also has positive airway pressure, but we use it for patients that are little sicker, little more serious, is kind of deteriorated and we're hoping to avoid intubation.

03:54 Now this also has the high positive pressure on inspiration just like CPAP, but remember CPAP doesn't change, it's continuous, it's constant. BiPAP means bi, 2, so positive airway pressure is what PAP stands for. BiPAP means 2 levels of positive airway pressure. So it's higher on inspiration, cool, it helps keep everything open, but it will decrease the work of breathing by having a lower positive pressure on expiration. So instead of having to breathe against a hair dryer, it's a little bit lower. Now we'll talk more about the actual settings as we get further in the presentation. But this is often used in exacerbations of COPD and in ARDS, acute respiratory distress syndrome. Now those patients are really sick. So, someone on a BiPAP, we're trying to keep them off the ventilator, we're trying to prevent them from having to be intubated, but they're going to be a pretty sick patient. Generally, as a rule, BiPAP patients are more intense, more sick than a CPAP patient.