NIPPV Initial Setup and Reassessment

Key Points

• NIPPV is initiated in selected spontaneous-breathing patients to support oxygenation and ventilation without invasive airway placement.
• Initial setup centers on FiO2, EPAP, IPAP, and a back-up respiratory rate.
• Treatment effectiveness should be reassessed at about 30 minutes with clinical response and, when ordered, ABG data.

Equipment

• Noninvasive ventilator interface and mask system
• Oxygen source with FiO2 control
• Bedside monitoring for respiratory status and oxygenation
• Access to arterial blood gas sampling workflow when ordered

Procedure Steps

1. Confirm the patient is an appropriate NIPPV candidate, including alertness and intact spontaneous drive to breathe.
2. Explain the purpose of NIPPV and prepare interface for tolerable fit.
3. Set initial FiO2 to meet oxygenation goals.
4. Set EPAP to provide expiratory distending pressure for recruitment and airway support.
5. Set IPAP to augment inspiratory support and improve carbon dioxide clearance.
6. Set a back-up respiratory rate as ordered (recognizing it does not replace spontaneous breathing in this context).
7. Start NIPPV and verify synchronization, comfort, and immediate physiologic response.
8. Reassess after approximately 30 minutes using clinical signs and ordered ABG results.
9. Continue, adjust, or escalate care based on response and safety findings.

Common Errors

• Initiating NIPPV in unsuitable patients → increased treatment failure and aspiration risk.
• Inadequate initial setting verification → delayed oxygenation/ventilation improvement.
• Skipping early 30-minute reassessment → delayed recognition of ineffective therapy.
• Delayed escalation after poor response → avoidable respiratory deterioration.

Related

• noninvasive-positive-pressure-ventilation - Concept-level explanation of EPAP/IPAP physiology and candidate selection.
• advanced-airways-and-intubation - Escalation pathway when noninvasive support fails.