NCLIP

Noninvasive Positive Pressure Ventilation

3 min read

Noninvasive Positive Pressure Ventilation

Key Points

  • Noninvasive positive pressure ventilation (NIPPV) can support breathing without endotracheal intubation in appropriate patients.
  • Best candidates are alert and maintain spontaneous respiratory drive.
  • NIPPV uses expiratory pressure (EPAP) and inspiratory pressure (IPAP) to improve oxygenation and ventilation.
  • Response should be reassessed after about 30 minutes, often including arterial blood gas evaluation.

Pathophysiology

NIPPV augments spontaneous breathing by applying two pressure levels through a noninvasive interface. EPAP supports alveolar recruitment and helps keep small airways open during expiration, which improves oxygenation. IPAP adds inspiratory support and increases tidal volume, improving carbon dioxide elimination.

Because support depends on patient-triggered breathing and airway protection, patient selection is critical. In an unsuitable patient, treatment failure can occur and aspiration risk increases.

Classification

  • EPAP (expiratory positive airway pressure): Lower pressure during exhalation that supports airway patency and recruitment.
  • IPAP (inspiratory positive airway pressure): Higher pressure during inhalation that augments tidal volume and CO2 clearance.
  • Back-up respiratory rate: Safety setting that supports minimum rate behavior without replacing spontaneous breathing in this context.

Nursing Assessment

NCLEX Focus

Priority items test whether the patient is an appropriate NIPPV candidate and whether early reassessment shows treatment success or failure.

  • Assess alertness, ability to protect airway, and adequacy of spontaneous breathing before initiation.
  • Monitor baseline and post-initiation respiratory effort, gas-exchange status, and tolerance of therapy.
  • Evaluate effectiveness after approximately 30 minutes using clinical reassessment and ordered ABG results.
  • Watch for signs of NIPPV failure and aspiration risk during ongoing support.

Nursing Interventions

  • Initiate core settings for spontaneous-breathing support: FiO2, EPAP, IPAP, and back-up RR.
  • Confirm mask/interface fit and comfort to reduce leak and improve pressure delivery.
  • Reassess early and adjust settings with the clinical team based on oxygenation, ventilation, and patient response.
  • Escalate promptly to advanced-airways-and-intubation when noninvasive support is ineffective or unsafe.
  • Educate patient on therapy purpose and coaching for synchrony when clinically feasible.

Candidate Selection Safety

Using NIPPV in an unsuitable clinical setting increases failure risk and potential aspiration harm.

Pharmacology

No specific medication protocol is detailed in this source section; treatment emphasis is ventilator pressure strategy and rapid reassessment.

Clinical Judgment Application

Clinical Scenario

An alert patient with worsening ventilation remains spontaneously breathing and is started on NIPPV with FiO2, EPAP, IPAP, and back-up rate settings.

Recognize Cues: Increased work of breathing but preserved responsiveness and respiratory drive. Analyze Cues: Patient may benefit from noninvasive pressure support before invasive airway escalation. Prioritize Hypotheses: Early response to NIPPV determines whether current strategy is adequate. Generate Solutions: Initiate settings, optimize fit, and schedule reassessment at 30 minutes with ABG when ordered. Take Action: Start NIPPV and perform structured reassessment. Evaluate Outcomes: Improved gas exchange and breathing effort support continued therapy; poor response prompts escalation.

Self-Check

  1. How do EPAP and IPAP serve different physiologic goals during NIPPV?
  2. Why is early reassessment at about 30 minutes critical after NIPPV initiation?
  3. Which patient characteristics suggest NIPPV may be unsafe or likely to fail?

그래프 뷰

백링크