NON INVASIVE VENTILATIONLOW AND HIGH FLOW OXYGEN DEVICES

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NON INVASSIVE VENTILATION WHAT IS NON INVASSIVE VENTILATION ?

ADVANTAGES • Avoids intubation• Reduces patients work load• Provides adequate oxygen• Improves quality of sleep• Allows patient to communicate • Allows patient to drink and eat • Reduces the chance of infection• Inexpensive

uses• Weaning trial• A/C Respiratory failure• Neuro muscular diseases• Copd • Pulomonary edema • Bronchiectasis• Poliomyelitis• Muscular dystrophy etc ..

Contraindications • Respiratory arrest• Uncoperative patients• Inability to protect airways• Trauma or burns in face• Facial or GI Surgery• Apnoea• Extreme anxiety• Obesity

Types of non invasive ventilators• Generally classified into 2

1. Volume pre set ventilators2. Pressure preset ventilators

Pressure pre set ventilators 2 modes• CPAP• BiPAP

NURSING RESPONSIBILITY• Check patients breath rate and ausculate • Maintain spo2 100%• Inform the physician regarding any abnormality in ABG Values• Always check for air leake• Give more importance to patients needs like suctioning ,or giving

sputum cups if secretions are present• Maintain a ABG CHART

Complications of CPAP and BiPAP• Insufficient ventillatory support• Mask leake• Skin trauma• Sputum retention • Nutritional deficiencies• Abdominal discomfort

OXYGEN DELIVERY METHODS /SYSTEMS • 2 SYSTEMS • LOW FLOW DELIVERY SYSTEMS• HIGH FLOW DELIVERY SYSTEMS

LOW FLOW OXYGEN DEVICES

• NASAL CANNULA• SIMPLE FACE MASK• PARTIAL REBREATHER MASK

HIGH FLOW DEVICES /SYSTEMS• TRANS TRACHEAL CATHETRES• VENTURI MASK• AEROSOL MASK• TRACHEOSTOMY COLLARS• T –PIECE • NON REBREATHING MASK WITH RESERVOIR AND ONE WAY VALVE• HIGH HUMIDITY FACE TENTS

Formula for calculating percentage of Fio2%• Fio2= 20% + (4 X oxygen liter flow)• 1 liters = 24 %• 2 liters =28 % etc

• Suppose if we deliver 6 litres of oxygen per min ,what is the Fio2

• ANS- Fio2 = 44% with 6 litres of O2 P/M

NASAL CANNULA • Flow rate - 2-6 litres per min• 24-45 percentage • Advantage – light weight ,comfortable,inexpensive and continuous

use with meals and activity.• Disadvantage – nasal mucosa drying

Nasal cannula

Oropharyngeal catheter• Flow rate – 1-6 Litres• Deliver 22-44 %• Adv – inexpensive and no need for tracheostomy• Dis adv – mucosal drying ,catheter should be changed frequently to

both nostrils

Oropharyngeal catheter /air way.

Simple face mask • Flow rate – 6-8 Litres• Deliver 40-60%• Adv – inexpensive and simple to use• Dis adv – mucosal drying ,poor fitting

Simple Face mask

Partial rebreather mask • Flow rate – 8-11 Litres• Deliver 50-75 %• Adv – moderate oxygen concentration • Dis adv – mucosal drying ,poorly fitting , must remove to eat.

Partial rebreather mask

Non rebreather mask• Flow rate – 10-12 Litres• Deliver 80- 100 %• Adv – High oxygen concentration• Dis adv – poorly fitting ,must remove to eat

Non rebreather mask

HIGH FLOW DEVICES

Trans tracheal catheter• Flow rate – 4 Litres/min• Deliver 60=100 %• Adv – more comfortable , concealed by clothings ,less o2 is needed to

achieve 100% saturation • Dis adv – requires frequent and regular cleaning and needs surgical

intervention

Trans tracheal catheters

Venturi mask • Flow rate – 4-6 l/min • Deliver 24-40 % • Adv – precise fio2 and additional humidity available• Dis adv – must be removed to eat

Colour Fi O2 O2 flow

Blue 24% 2 l/min

White 28% 4 l/minOrange 31% 6 l/minYellow 35% 8 l/minRed 40% 10 l/minGreen 60% 15 l/min

Trans tracheal catheter• Flow rate – 4 Litres/min• Deliver 60=100 %• Adv – more comfortable , concealed by clothings ,less o2 is needed to

achieve 100% saturation • Dis adv – requires frequent and regular cleaning and needs surgical

intervention

Aerosol mask • Flow rate – 8-10 Litres/min• Deliver 21- 100% fio2 based on nebulizer setting• Adv – good humidity and accurate Fio2• Dis adv – uncomfortable for some

Aerosol mask

Tracheostomy collar • Flow rate – 8-10 Litres/min• Deliver 30- 100 %• Adv – good humidity , comfortable ,fairly accurate Fio2• Dis adv – requires surgical intervention

Tracheostomy collar

T-piece• Flow rate – 8-10 Litres/min• Deliver 60=100 %• Adv –good humidity , comfortable ,fairly accurate Fio2• Dis adv – heavy with tubings

T-piece

Face tent • Flow rate – 8-10 Litres/min• Deliver 30- 100 %• Adv –good humidity , comfortable ,fairly accurate Fio2• Dis adv – bulky and cumbersome

Face tent

Complications Of Oxygen therapy• Infection• Combustion• Oxygen toxicity• Atlectasis• Retrolental fibroplasis• Retinal damage• Asphyxia

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