non-invasive ventilation in pre-hospital emergency medicine
TRANSCRIPT
Advantages- Reduced need for sedation- Improved mucociliary clearance- Reduced intubation rate- Reduced rate of nosocomial
infectionsRecommend treatment (level A) for COPD & cardiopulmonary edema
Content provided by: Dr. M. Roessler, Center for Anesthesiology, Emergencyand Intensive Care Medicine – University Medical Center Göttingen
* Trademark used under license
Non-invasive ventilation in pre-hospital emergency medicine
Hypercapnic respiratory failureHypoxemic respiratory failure
NOIneffective
Yes
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Advantages– Reduced need for sedation– Improved mucociliary clearance – Reduced intubation rate– Reduced rate of nosocomial infections
Recommend treatment (level A) for COPD & cardiopulmonary edema
Content provided by: Dr. M. Roessler, Center for Anesthesiology, Emergency and Intensive Care Medicine – University Medical Center Göttingen
Oxylog® VE300
Oxylog® 3000 plus
1. CPAP 5 mbar
If comfortable: Increase CPAP to 10 mbar
If comfort reduced: Reduce CPAP to 5 mbar
Keep settings with highest CPAP comfort
2. PEEP + PS: +5 mbar
If comfortable: Increase PS by steps of +5 mbar up to max. +20 mbar (PEEP + PS)
If comfort reduced: Reduce PS by 5 mbar
Keep settings with highest PEEP + PS comfort
Only if no improvements within 5':
3. BIPAP* I:E = 1:1, RR = 20/min– lower pressure like PEEP
– upper pressure proceed like 2.
IndicationsAcute hypoxemic respiratory failure.= Oxygenation failure due to intrapulmonary
shunt e. g. cardiopulmonary edema e. g. pneumonia
Acute hypercapnic respiratory failure= Respiatory failure with ventilatory
e. g. decompensated COPD
How to useStart with: 100% – FIO
2 1.0 – reduce if needed, target:
SpO2 above 90% – CPAP / PEEP ± 5 mbar
– Trigger as low as possible – Pressure support +20 mbar
(+ 5 PEEP + 15 PS = 20 mbar inspiratory pressure) – Observe patient‘s comfort level– Hold the mask initially, adjust once well adapted
Objective:– Respiration rate < 35/min– Tidal volume > 3 ml/kg ideal body weight – Decreased use of respiratory musclesContraindications
– Apnea or cardiac arrest– Hemodynamic instability – Acute life-threatening hypoxia– Extreme agitation– Coma or uncontrollable confusion
(unrelated to hypercapnia)– Increased risk of regurgitation
and aspiration– Acute or imminent airway obstruction
Re-evaluate treatment if symptoms are observed
– Advanced deterioration of consciousness – Extreme agitation– Uncontrollable aerophagy– Regurgitation– Aspiration
Indicationfor intubation
NIV Intubationand IPPV
Effective
Success criteriaImproved oxygenation– SpO
2 > 90%
Improvement of ventilatory status– Decrease in respiratory and heart rate – Decrease in respiration rate ≥ 20%– Less use of accessory muscles – Improved alveolar ventilation– Improved etCO
2 (decreased PaCO
2)
– Subjective improvement– Improvement in the patient’s level of consciousness