Intubation is a critical 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.
Latest posts by Scott Weingart (see all)
- EMCrit Podcast 240 – Renal Compartment Syndrome & It's all about the Venous Side and We've Been Fracking it up for Years - February 10, 2019
- EMCrit 239 – Vent Alarms = Code Blue - January 26, 2019
- EMCrit Wee – Getting Things Done 2019 Update - January 16, 2019