What Is Non Invasive Ventilation 

Non-invasive ventilation (NIV) is a type of mechanical ventilation that is used to support breathing in individuals with respiratory failure, without the need for invasive procedures such as intubation or tracheostomy. NIV can be delivered through various types of interfaces such as nasal masks, full face masks, or helmet interfaces, and it can be used in both acute and chronic respiratory failure.

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In this article, we will provide a comprehensive overview of non-invasive ventilation, including the indications, benefits, types of interfaces, modes of ventilation, and potential complications.

Indications for Non-Invasive Ventilation

Non-invasive ventilation is indicated for patients with respiratory failure who are able to breathe spontaneously, but require additional support to maintain adequate gas exchange. NIV can be used in both acute and chronic respiratory failure, and it is commonly used in the following clinical scenarios:

1.      Acute exacerbations of chronic obstructive pulmonary disease (COPD)

2.      Acute cardiogenic pulmonary edema

3.      Acute respiratory distress syndrome (ARDS)

4.      Neuromuscular disorders

5.      Obesity hypoventilation syndrome (OHS)

6.      Sleep apnea syndromes

7.      Chronic obstructive pulmonary disease (COPD)

8.      Obesity hypoventilation syndrome (OHS)

9.      Chest wall deformities

10. Bronchiectasis

11. Cystic fibrosis

Benefits of Non-Invasive Ventilation

1.      Improved oxygenation: NIV can improve oxygenation by providing positive airway pressure and improving ventilation-perfusion matching.

2.      Reduced work of breathing: NIV can reduce the work of breathing by providing additional respiratory support, allowing the respiratory muscles to rest and recover.

3.      Improved gas exchange: NIV can improve gas exchange by increasing tidal volume and reducing dead space ventilation.

4.      Improved ventilation: NIV can improve ventilation by providing positive airway pressure and reducing airway resistance.

5.      Reduced need for intubation: NIV can reduce the need for intubation and mechanical ventilation in patients with respiratory failure, which can reduce the risk of complications associated with invasive mechanical ventilation.

Types of Non-Invasive Ventilation Interfaces

1.      Nasal masks: Nasal masks are the most commonly used interfaces for NIV. They cover the nose and are secured in place by straps.

2.      Full face masks: Full face masks cover both the nose and mouth and are secured in place by straps.

3.      Helmet interfaces: Helmet interfaces cover the entire head and neck and are secured in place by an adjustable collar.

4.      Mouthpieces: Mouthpieces are used for patients who are able to breathe spontaneously but require additional respiratory support.

Modes of Non-Invasive Ventilation

1.      Continuous positive airway pressure (CPAP): CPAP provides a continuous positive pressure throughout the respiratory cycle, which can improve oxygenation, reduce the work of breathing, and improve ventilation.

2.      Bilevel positive airway pressure (BiPAP): BiPAP provides two levels of pressure, one during inspiration and one during expiration. This can improve gas exchange, reduce the work of breathing, and improve ventilation.

3.      Adaptive servo-ventilation (ASV): ASV is a mode of ventilation that adjusts the respiratory rate and tidal volume to meet the patient's respiratory needs.

4.      Volume-assured pressure support (VAPS): VAPS is a mode of ventilation that adjusts the inspiratory pressure to maintain a target tidal volume.

Complications of Non-Invasive Ventilation

1.      Skin breakdown: Pressure from the interface can cause skin breakdown, particularly around the nose and mouth.

2.      Discomfort: Patients may experience discomfort from the interface or the pressure used.

3.      Air leakage: Air leakage around the interface can reduce the effectiveness of the ventilation and cause