12th January 2024

Non-Invasive Ventilation (NIV)

It uses a tightly fitted mask covering nose and mouth and delivers higher inspiratory pressures, which increase tidal volume and lower expiratory pressures at the end of expiration.

NIV Settings

Initial inspiratory positive airway pressure (IPAP) is generally set at 12cmH2O, and the expiratory positive airway pressure (EPAP) at 4cmH2O.

There can be an increment of 2-4 cmH2O in IPAP every 15 minutes to achieve an adequate tidal volume.

Indications for NIV 

1. Acute exacerbation of COPD (T2RF not responding to optimal medical management)
2. Decompensated obstructive sleep apnoea/obesity hypoventilation syndrome
3. T2RF secondary to neuromuscular weakness or chest wall deformity (Myasthenia Gravis, Guillain-Barre syndrome, amyotrophic lateral sclerosis)

Contraindications for NIV

1. Impaired consciousness or confusion (GCS <8)
2. Life-threatening hypoxemia
3. Facial surgery or burns
4. Undrained pneumothorax
5. Vomiting