non-invasive ventilation in pre-hospital emergency medicine

Advantages- Reduced need for sedation- Improved mucociliary clearance- Reduced intubation rate- Reduced rate of nosocomial

infectionsRecommend treatment (level A) for COPD & cardiopulmonary edema

Content provided by: Dr. M. Roessler, Center for Anesthesiology, Emergencyand Intensive Care Medicine – University Medical Center Göttingen

* Trademark used under license

Non-invasive ventilation in pre-hospital emergency medicine

Hypercapnic respiratory failureHypoxemic respiratory failure

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Advantages– Reduced need for sedation– Improved mucociliary clearance – Reduced intubation rate– Reduced rate of nosocomial infections

Recommend treatment (level A) for COPD & cardiopulmonary edema

Content provided by: Dr. M. Roessler, Center for Anesthesiology, Emergency and Intensive Care Medicine – University Medical Center Göttingen

Oxylog® VE300

Oxylog® 3000 plus

1. CPAP 5 mbar

If comfortable: Increase CPAP to 10 mbar

If comfort reduced: Reduce CPAP to 5 mbar

Keep settings with highest CPAP comfort

2. PEEP + PS: +5 mbar

If comfortable: Increase PS by steps of +5 mbar up to max. +20 mbar (PEEP + PS)

If comfort reduced: Reduce PS by 5 mbar

Keep settings with highest PEEP + PS comfort

Only if no improvements within 5':

3. BIPAP* I:E = 1:1, RR = 20/min– lower pressure like PEEP

– upper pressure proceed like 2.

IndicationsAcute hypoxemic respiratory failure.= Oxygenation failure due to intrapulmonary

shunt e. g. cardiopulmonary edema e. g. pneumonia

Acute hypercapnic respiratory failure= Respiatory failure with ventilatory

e. g. decompensated COPD

How to useStart with: 100% – FIO

2 1.0 – reduce if needed, target:

SpO2 above 90% – CPAP / PEEP ± 5 mbar

– Trigger as low as possible – Pressure support +20 mbar

(+ 5 PEEP + 15 PS = 20 mbar inspiratory pressure) – Observe patient‘s comfort level– Hold the mask initially, adjust once well adapted

Objective:– Respiration rate < 35/min– Tidal volume > 3 ml/kg ideal body weight – Decreased use of respiratory musclesContraindications

– Apnea or cardiac arrest– Hemodynamic instability – Acute life-threatening hypoxia– Extreme agitation– Coma or uncontrollable confusion

(unrelated to hypercapnia)– Increased risk of regurgitation

and aspiration– Acute or imminent airway obstruction

Re-evaluate treatment if symptoms are observed

– Advanced deterioration of consciousness – Extreme agitation– Uncontrollable aerophagy– Regurgitation– Aspiration

Indicationfor intubation

NIV Intubationand IPPV

Effective

Success criteriaImproved oxygenation– SpO

2 > 90%

Improvement of ventilatory status– Decrease in respiratory and heart rate – Decrease in respiration rate ≥ 20%– Less use of accessory muscles – Improved alveolar ventilation– Improved etCO

2 (decreased PaCO

2)

– Subjective improvement– Improvement in the patient’s level of consciousness