What are primary goals of noninvasive ventilation (NIV) and how should settings be adjusted to meet goals?

Updated: Jun 18, 2020
  • Author: Guy W Soo Hoo, MD, MPH; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Answer

Adequate ventilation and oxygenation, correction of respiratory failure, and adequate patient tolerance and comfort are the primary goals of noninvasive ventilation, and adjustments are made to achieve these endpoints. Initial settings focus on achieving adequate tidal volumes, usually in the range of 5-7 mL/kg. Additional support is provided to reduce the respiratory rate to less than 25 breaths/minute. Oxygen is adjusted to achieve adequate oxygenation, with a pulse oximetry goal of greater than 90%. Serial arterial blood gas measurements are essential to monitor the response to therapy and to guide further adjustments in the ventilator. The following provides some guidance on titration of ventilator settings in patients with respiratory distress and who have never been placed on noninvasive ventilation. In those patient who may have chronic noninvasive support, the initial values should be based on prior support levels. The listed levels may be inadequate and would thus increase the likelihood of intolerance or failure. If there is uncertainty, it is important to perform a bedside titration with increasing levels based on patient comfort or exhaled tidal volumes. These adjustments can be made within minutes and can be done without obtaining blood gases.


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