noninvasive positive pressure mechanical ventilation

Noninvasive positive pressure mechanical ventilation is a new method for the treatment of chronic obstructive pulmonary disease and bronchial asthma. Non-invasive positive pressure mechanical ventilation (NIPPV) refers to the connection of a patient through a nasal mask, mask or interface, without the need for endotracheal intubation or tracheotomy. With the development of medicine, improvement of ventilator and ventilation modes, and improvement of clinical application techniques, the clinical application of NIPPV has become more and more popular since the late 1980s, and has become a treatment for respiratory failure, especially early respiratory failure and chronic respiratory failure. An important means of the patient. The advantages of non-invasive ventilation ventilator are that there is no need for endotracheal intubation, the application is convenient, the patient is easy to accept, can effectively relieve breathing difficulties, and can be used in a general ward. In foreign countries, the patient can apply it as long as the application method is mastered at home. Treatment of diseases: respiratory failure in the elderly Indication Have moderate to severe dyspnea, assisted respiratory muscles participate in breathing and chest and abdomen contradictory movements, moderate to severe acidosis (pH 7.30 - 7.35), hypercapnia (PaCO2 45-60mmhg), respiratory rate greater than 25 times /Minute. Prevent respiratory failure: support after surgery. Rehabilitation treatment: COPD remission, neuromuscular diseases, etc. Contraindications Respiratory depression or cessation, unstable cardiovascular system (hypotension, arrhythmia, myocardial infarction), lethargy, disturbance of consciousness or uncooperative, easy to afferent (abnormal swallowing reflex, severe gastrointestinal bleeding), sputum viscous Or a large number of airway secretions, recently had facial or gastroesophageal surgery, head and face trauma, inherent nasopharynx abnormalities, extreme obesity, severe flatulence. Surgical procedure Positive airway pressure ventilation through nasal/oral masks assists breathing through pressure-supported ventilation. For patients with respiratory disorders or failures caused by different causes, it can improve ventilation, relieve respiratory muscle fatigue, and reduce respiratory work. Consumption is adapted to multiple respiratory failures and is described in detail in the article. The patient's respiratory tract is connected to a relatively closed environment through the nose/mask, the pipeline and the ventilator. The working mode of the ventilator is continuous positive airway pressure and bi-level positive airway pressure. The latter is commonly used in clinical practice. [Operation method] 1. Appropriate monitoring conditions. 2. The patient takes a sitting position or a lying position. 3. Select the appropriate connector (cover, nasal cannula or interface, etc.). 4. Select the ventilator. 5. With a headband (encourage the patient to support the cover, to avoid the tension of the fixed strap is too high). 6. Start and connect the ventilator. 7. Start with low pressure (capacity), with self-trigger (with backup frequency) mode; pressure limit type: suction pressure 8-12cmH2O, exhalation pressure 3-5cmH2O; capacity limited type: 10ml/Kg. 8. Gradually increase the inspiratory pressure (to 10-20 cmH2O) or tidal volume (to 10-15 ml/Kg) according to the patient's tolerance to achieve relief of shortness of breath, slow down respiratory rate, increase tidal volume and ideal person Machine synchronization is the goal. 9. Pay attention to monitoring blood oxygen saturation, give oxygen when needed, so that SatO2>90%. 10. Check for air leaks and adjust the tension of the strap if necessary. 11. Add a humidifier when indicated. 12. Consider the use of shallow sedatives for patients with hyperactivity (eg intravenous chloromethylol 0.5mg) 13. Repeatedly encourage and examine patients as needed. 14. Intermittent monitoring of blood gas (after 1-2 hours, depending on the need). [Common ventilation modes and parameters] 1. Ventilation mode A variety of ventilation modes can be applied to NIPPV. Clinically, a well-synchronized mode such as pressure support (PSV) is usually used. Some new ventilation modes with better man-machine synchronization performance, such as pressure regulation capacity control (PRVC) and proportional assist ventilation (PAV), have been reported for NIPPV. Due to the emphasis on patient comfort during NIPPV treatment, it is recommended to use triggering methods with better synchronous triggering performance, such as flow triggering, capacity triggering or automatic flow tracking (Auto-track). 2. Parameters (1) tidal volume 510ml/Kg (2) Respiratory frequency 16 to 30 beats / min (3) Inspiratory flow decreasing type, sufficiently variable, peak value: 40 ~ 60L / min (4) Inspiratory time 0.8 to 1.2 seconds (5) Inspiratory pressure 1025cmH2O (6) Expiratory pressure (PEEP) 3 ~ 5cmH2O (4 ~ 8cmH2O for type I respiratory failure)