EMCrit Podcast 19 – Non-Invasive Ventilation

Intubation is a sexy procedure, there is no doubt about it.

NIV does not have the glamour; it’s not nearly as cinematic. But for the patient, to spend 30 minutes on a NIV mask is preferable to a couple of days on the ventilator. In this episode, I discuss some of the basic ideas and methods of NIV.

It is pretty simple as the mode only has 3 main settings:

FiO2 – set based on oxygen requirements, just like on the vent

PEEP/EPAP/CPAP – all the same thing, set this based on OXYGENATION needs. If the patient’s sat is low, start at 5 cm H20 and titrate up to 15-17 as needed.

PSV/IPAP – this setting is for ventilation. If your patient does not have ventilation problems, they don’t need PSV. If they do, start at 5 cm H20 and titrate to 15-17.

Yes, that’s right, I did not tell you to put every patient at 10/5. Very few of your patients will have both ventilatory and oxygenation problems. Asthma and COPD need inspiratory support. APE, atelectasis, pneumonia patients need PEEP.

I also talk about sedation while a patient is on NIV.

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Comments

  1. Mohd Anizan Aziz says

    Hi Scott,

    I have just listened to your wonderful lecture.
    I tend to believe that here in this country, we at ED are not equipped with machines that are similar standard to that of in the ICUs. The ventilators that we have here are more of rudimentary…sort of.

    So many times I’ve encountered patients whom if we gave enough attention and if NIV get initiated aggrasively and timely , these patients might not need to be intubated at all. Even so, if NIV being given, the settings that we set to the patient were not proper and as such they still ending up intubated.

    I must confess sir, that I’ve tried reading literature pertaining to NIV and manuals on how to use them to patients, but I’ve not quite understood them well. Not until l I listened to your podcast.
    I have few questions with regards to the NIV, probably I pose them via email.

    Thanks in advance for ur future input.

    regards

    Mohd

  2. Jose D. Torres, Jr. of NYHQ says

    Any good resources to read up on em noninvasive positive pressure ventilation that will not turn me comatose?
    Any sentinel articles to look at? or just look it up on your em crit text?

  3. suja mohan says

    Dear Dr.W,
    Iam a new ED educator at QHC. You are my Guru and resource.Yes, I do agree with the MD who wrote WWWD. You inspire me tremendously.I am always trying to bring the upstairs care downstairs.Thanks to you.

  4. Michael Barrow says

    Dr. Weingart,

    I am a newer paramedic in an urban service. I have always been a big believer in NIV, but your explanation and tips have helped me hone this skill even more. Our ventilators in the field are pretty terrible. We have very limited options, our choice is either to bag, CPAP, or intubate mostly. With someone that has no access to BiPap, NIV with a NC and a BVM has revolutionized by airway care! The service I work for only has Versed/Fentanyl to intubate with (which, as you know) can make for some pretty messy and difficult intubations. This remedy has kept me from intubating crashing patients for long enough until better meds and a more controlled environment were available. It has even kept some of them from being intubated at all! Thanks for your wonderful insights!

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