Noninvasive positive pressure ventilation (NPPV)

See(( Noninvasive ventilation))


Other terms have been used in the medical literature to describe NIV: non-invasive positive pressure ventilation(NPPV or NIPPV).

The delivering of mechanically assisted breaths via a tight fitting nasal or facial mask, obviating the need for endotracheal intubation.


Non-invasive ventilation (NIV) refers to the use of breathing support administered through a face mask, nasal mask, or a helmet. 


The mask is tightly fitted to the face or around the head, but without a need for tracheal intubation.

The assisted ventilation is usually pressured cycled.

Air, usually with added oxygen, is given through the mask under positive pressure.



The amount of pressure is alternated depending on whether someone is breathing in or out. 


Non-invasive ventilation is used in acute respiratory failure caused by a number of medical conditions, most prominently chronic obstructive pulmonary disease (COPD).



Studies have shown that use of NIV reduces the need for invasive ventilation and its complications. 



NIV may be used on a long-term basis in people who cannot breathe independently as a result of a chronic condition.



NIV for acute respiratory failure is used for: severe exacerbations of chronic obstructive pulmonary disease (COPD) and acute decompensated heart failure and other acute conditions.



Its most common indication is for acute non-invasive ventilation is for acute exacerbation of chronic obstructive pulmonary disease. 



NIV is only indicated if the CO2 is acutely increased to the point that the acidity levels of the blood are increased (pH<7.35).


Its rationale for use in COPD and chronic respiratory failure is to reduce work of breathing and improve respiratory mechanics,

With severe COPD the lungs are hyperinflated because of emphysema as small airways abnormalities that together increase lower airway resistance.

Hyperinflation leads the diaphragm muscle atrophy.

The combination of diaphragm muscle atrophy, airflow obstruction, and the possible effects of hypercapnia on respiratory muscle function lead to increased respiratory muscle load in patients with COPD with chronic respiratory failure.

NPPV through its provision of ventilatory support offsets diaphragmatic dysfunction and reduces work of breathing, providing rest to the diaphragm and improvement in chronic hypercapnia.

NPPV or a positive pressure ventilation delivery to a non-invasive interface, such as a facemask, can be used to improve accident and carbon dioxide gas exchange.

In patients with acute respiratory failure due to an acute exacerbation of COPD, in-hospital use of NPPV has been associated with decreased mortality, decreased need for intubation, shorter hospital length of stay, and fewer complications.

Use contraindicated with impending cardiac or respiratory arrest, encephalopathy, active upper gastrointestinal bleeding, hemodynamic instability, unstable cardiac arrhythmias, inability to protect the airway, excess secretions, upper airway obstruction, risk for aspiration, and deformity of the face by trauma or surgery.

Its use should not delay the use of invasive ventilation, when necessary.

It is a supportive management and must be accompanied by treatment for the underlying medical process leading to respiratory deficiency.

Beneficial in chronic obstructive pulmonary disease exacerbations, carcinogenic pulmonary edema, hypoxemia with respiratory failure in immunocompromised individuals with pulmonary infiltrates and as an adjunct in ventilation weaning.

NIV is not the same as continuous positive airway pressure (CPAP), which applies a single level of positive airway pressure throughout the whole respiratory cycle.



CPAP does not deliver ventilation but is occasionally used in conditions also treated with NIV.


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