Pearls for Non-Invasive Positive Pressure Ventilation1. CPAP and BiPAP are useful tools for treating COVID19.
2. Oxygenating the patient is the end goal.
3. Ensure a viral filter is attached to the exhaust line of CPAP/BiPAP device.
Non-invasive Positive Pressure Ventilation (NIPPV)
Non-invasive ventilation is a category of treatments used to help restore a patient’s balance of oxygen supply and demand without the use of intubation. These treatments work to increase the positive pressure of ventilation and help the patient to return to a homeostatic level. Two important concepts for review:
PEEP in Action
NIPPV Tools of the Trade
HFNC – High flow nasal cannula
CPAP – Continuous positive airway pressure
BiPAP – Bilevel positive pressure airway pressure
Safe Set up of CPAP/BiPAP
Common Nursing Problems
Possible solutions – Collaborating in care, educating the patient on the device, talking them through the equipment, and at times anxiolytic medications 4.
Potential solutions – Anti-emetic medications, education for the patient to remove the mask if they feel they might vomit, or not putting the patient on CPAP/BiPAP if the risk is too high 4.
Potential solutions – Adjust head straps, change to a different mask size, or make sure patient is not adjusting the mask themselves. This can be a hazard as shedding virus can be expelled 4.
1.Australian and New Zealand Intensive Care Society (ANZICS). “COVID19 Guidelines” Open Access. Version 1. 16 Mar. 2020. https://www.anzics.com.au/wp-content/uploads/2020/03/ANZICS-COVID-19-Guidelines-Version-1.pdf
2.Hardavella, Georgia et al. “Oxygen devices and delivery systems.” Breathe (Sheffield, England) vol. 15,3 (2019): e108-e116. doi:10.1183/20734735.0204-2019
3.Rose, Louise. “Management of critically ill patients receiving noninvasive and invasive mechanical ventilation in the emergency department.” Open access emergency medicine : OAEM vol. 4 5-15. 21 Mar. 2012, doi:10.2147/OAEM.S25048
4. Gavaghan, Susan, Jeffries, Marian. Your patient’s receiving noninvasive positive-pressure ventilation, Nursing2006: May 2006 – Volume 36 – Issue 5 – p 46-47 doi: 10.1097/01.NURSE.0000393383.70540.53