the practical approach for NIV..part 4

CPAP:

For patients with suspected ACPE its reasonable to set the CPAP pressure at 10cm H2O. This pressure can be adjusted up or down depending on patient comfort.
Oxygen should be titrated based on PCO2, PaO2 and titrated to the patient SpO2 at the bedside.

BiPAP:

For patients receiving BiPAP start with an IPAP of between 12-15cm H2O, and and EPAP of between 4-7cm H2O.
These pressure can be titrated up or down depending on the combination of clinical effect as well as patient comfort.
Failure to improve oxygenation should prompt sn increase in fractional inspired oxygen and EPAP.
Failure to improve the hypercarbia should lead to an increase in IPAP.

Take Home Points:

Based on current evidence pressures should not exceed 25cm H2O at any point regardless of the mode of NIV being used.
In order to maintain the pressures, it is important to achieve a good seal with the NIV mask.

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The pressure volume loop...

In the pressure-volume loop below, cardiac work is best represented by: the area of the curve the slope of the line from points C to D the distance of the line from points C to D the slope of a line from points A to D .. .. ... .... ... .... .... .... In the pressure-volume loop below, cardiac work is best represented by: the area of the curve Cardiac work is the product of pressure and volume and is linearly related to myocardial oxygen consumption. Cardiac work is best represented by the area of the curve of a pressure-volume loop.

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