Undersupervision :

Dr: Mohamed Abdel-Mohaymen

Prepared by :
Abdulrahman Younis Ahmed
G38
Introduction
Non-invasive positive pressure ventilation involves the delivery of oxygen into
the lungs via positive pressure without the need for endotracheal intubation. It
is used in both acute and chronic respiratory failure but requires careful
monitoring and titration to ensure its success and avoid complications. This
activity reviews the physiology behind non-invasive positive pressure
ventilation, its indications and contraindication

Indications
1. acute or acute-on-chronic respiratory acidosis secondary to COPD
exacerbation where pH </= 7.35
2. CPAP is the prevention of endotracheal intubation and mechanical
ventilation in a patient that is not immediately deteriorating
3. continuous positive airway pressure (CPAP) for cardiogenic pulmonary
edema
4. immunocompromised patients with ARF
5. Post-operative ARF
6. As palliation to dyspneic patients in the setting of terminal cancer or
other terminal conditions
7. Chest trauma patients with ARF
8. Prevention of post-extubation respiratory failure in high-risk patients
9. obstructive sleep apnea
10. respiratory failure secondary to neuromuscular disease,
11. and restrictive thoracic disorders.

Contraindications
Absolute Contraindications
Facial trauma/burns
 Fixed upper airway obstruction
 Active vomiting
 Respiratory or cardiac arrest
Relative Contraindications

1
  A recent facial, upper airway, or upper GI tract surgery
 Inability to protect the airway
 Life-threatening hypoxemia
 Medical or hemodynamic instability (hypotensive shock, myocardial
infarction requiring intervention, uncontrolled ischemia or
arrhythmias)
 Altered mental status/agitation ***
 Bowel obstruction
 Copious respiratory secretions
 Focal consolidation
 Undrained pneumothorax
 Severe co-morbidity

References

1. https://www.ncbi.nlm.nih.gov/books/NBK578188/
2. Slutsky AS. History of Mechanical Ventilation. From Vesalius to Ventilator-induced Lung Injury.
Am J Respir Crit Care Med. 2015 May 15;191(10):1106-15. [PubMed]