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An easier path to breathing help in the ICU and beyond
by Valerie Neff Newitt

Healthy individuals rarely stop to think about breathing; it is a simple matter of in-and-out. But when patients are unable to pull adequate air and oxygen into their lungs, respiratory distress or failure may occur.
Thanks to evolving technology, help is available. Machines called ventilators can pump life-preserving air into a patient’s lungs. And even better news for the patient is the fact that sometimes this can be accomplished without the use of internally placed airways.

What is noninvasive ventilation?
Noninvasive ventilation (NIV) is a term that refers to the use of external breathing support. NIV provides oxygen through a mask over the patient’s face or nose. In comparison, invasive ventilation is delivered
via tracheostomy or endotracheal tubes. While invasive ventilation can be a lifesaving technique, complications can occur, including injury to the trachea and larynx, speech and swallowing disabilities,  entilatorassociated pneumonia, and more. Noninvasive methods may be just as — or even more — effective and present less risk when used in appropriately chosen patients.

NIV is considered a first line of therapy in many critical care hospitals. For example, it may be used during surgery when a patient is under general anesthesia that can disrupt normal breathing. It is also used to treat acute exacerbations of chronic obstructive pulmonary disease and asthma, congestive heart failure-related respiratory issues, pneumonia, postoperative respiratory distress or failure, neuromuscular respiratory failure, cystic fibrosis, and other conditions.

The use of NIV has reached beyond hospitals to the pre-hospital emergency medical system arena. Specific patients whose lungs are filled with fluid, including those with acute congestive heart failure and acutely ill
dialysis patients, can find great benefit. This pre-hospital use of NIV often results in the patient avoiding invasive ventilation.

Terms you may hear
If you or a family member need ventilatory assistance, you may hear words that are new to you. However, there is no need to feel intimidated once you understand what they mean:

  • Hypoxemia is when there is too little oxygen in the blood.
  • Hypercapnia is when there is too much carbon dioxide in the blood.
  • Oxygen therapy is the process of providing oxygen-enriched gas to a person.
  • Ventilators are machines that support breathing. They can help people breathe easier, or perform the breathing activity for people who cannot breathe on their own.
  • Ventilation enhances oxygen delivery to the lungs and helps to remove carbon dioxide from the body. Carbon dioxide is a waste gas that can be toxic.
  • Interfaces serve as the connection between patient and ventilator, delivering gas to the patient through a set of flexible tubes called a patient circuit, and through a mouthpiece, nasal mask, orofacial mask, full face mask, nasal pillows, or a helmet. Usually, the smallest mask that provides a proper fit and prevents gas leakage is the most effective. This varies from patient to patient.
  • Monitors measure pressure, volume, and flow, and provide alarms if measurements are out of the proper range.

The good news

For patients, NIV presents real advantages. NIV results in lower cost when compared to invasive ventilation. Patients who use NIV usually spend less time using the ventilator and have shorter hospital stays due to fewer complications. Patients also report greater ease of interaction and communication, and they generally have an improved patient experience.

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