Non-invasive ventilation, better known as NIV, consists of a method to help a person's breathing, through devices that are not introduced into the respiratory system, as is the case of intubation that requires mechanical ventilation, also called breathing. by appliances. This method works by facilitating the entry of oxygen through the airways due to an air pressure, which is applied with the aid of a mask, which can be facial or nasal.
Generally, the pulmonologist recommends non-invasive ventilation for people who have chronic obstructive pulmonary disease, also called COPD, asthma, pulmonary edema due to heart problems and obstructive sleep apnea syndrome, the most used type being CPAP.
In cases where a person has difficulty breathing, with falling oxygen levels in the blood or do not breathe, non-invasive ventilation is not indicated, and other techniques should be performed to ensure more oxygen supply.
What is it for
Non-invasive ventilation serves to improve gas exchanges, facilitating breathing through pressure that exerts on the opening of the airways and aiding in the movements of inhalation and exhalation. This method can be indicated by a pulmonologist or general practitioner and is performed by a physiotherapist or nurse in people who have the following conditions:
- Respiratory failure;
- Chronic obstructive pulmonary disease;
- Pulmonary edema caused by heart problems;
- Asthma;
- Acute respiratory distress syndrome;
- Breathing difficulty in immunocompromised people;
- Patients who could not be intubated;
- Thoracic trauma;
- Pneumonia.
Most of the time, non-invasive ventilation is used in conjunction with treatment with medications and has the advantages of being a method that offers less risk of infection, does not require sedation and allows the person to speak, eat and cough during use of the mask. As it is easy to use, there are portable models that can be used at home, as is the case with CPAP.
Main types
The non-invasive ventilation devices work as ventilators that release air, increasing the pressure in the airways, facilitating gas exchange and some models can be used at home. In general, these devices require specific regulation by physiotherapy and pressure is applied depending on each person's respiratory condition.
The types of devices used in non-invasive ventilation have several interfaces, that is, there are different masks so that the pressure of the device is applied over the airways, such as nasal, facial, helmet-type masks, which are placed directly in the mouth. Thus, the main types of NIV are:
1. CPAP
CPAP is the type of non-invasive ventilation that works by applying continuous pressure during breathing, this means that only one pressure level is used, and it is not possible to adjust the number of times the person will breathe.
This device can be used by people who have control over their breathing and it is contraindicated for people who have neurological changes or breathing problems that make it difficult to control their breathing. CPAP is widely used for people with sleep apnea, as it allows the airways to remain open at all times, maintaining the passage of oxygen constantly during the period that the person is sleeping. Learn more about how to use and care for CPAP.
2. BiPAP
BiPAP, also called Bilevel or Positive Biphasic Pressure, favors breathing through the application of positive pressure on two levels, that is, it helps the person during the inspiration and expiration phase, and the respiratory rate can be controlled from a pre definition of the physiotherapist.
Furthermore, the pressure is triggered by the person's breathing effort and then, with the help of BiPAP, it is possible to maintain the breathing movements continuously, not allowing the person to go without breathing, being very indicated for cases of respiratory failure.
3. PAV and VAPS
The VAP, known as Proportional Assisted Ventilation, is the type of device most used in hospitals in the ICUs and works adapting to the respiratory needs of the person, so the air flow, the respiratory rate and the pressure it exerts on the airways changes according to the person's effort to breathe.
VAPS, which is called Support Pressure with Guaranteed Volume, is the type of ventilator also used in hospitals, which works from the pressure regulation by a doctor or physiotherapy, according to the person's need. Although it can be used in non-invasive ventilation, this device is more used to control the breathing of people in invasive ventilation, that is, intubated.
4. Helmet
This device is indicated for people who have Chronic Obstructive Pulmonary Disease, who entered the Intensive Care Unit, in addition to being the first option for people in whom the access route is difficult, due to trauma to the face, or for those in whom noninvasive ventilation is planned for a long period.
The difference with other types of non-invasive ventilation is the advantage of providing oxygen to the person more quickly, avoiding adverse effects and being able to provide food to the person.
When not indicated
Noninvasive ventilation is contraindicated in cases where the person has conditions such as cardiorespiratory arrest, loss of consciousness, after surgery on the face, trauma and burns on the face, obstruction of the airways.
In addition, care should be taken to use this method in pregnant women, and people who are undergoing tube feeding, with morbid obesity, anxiety, agitation and claustrophobia, which is when a person has the feeling of being trapped and the inability to stay indoors. Find out more about how claustrophobia is treated.
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Bibliography
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- SCHETTINO, Guilherme P. P. et al. Non-invasive mechanical ventilation with positive pressure. J. bras. pneumol. Vol.33, suppl.2. 92-105, 2007
- HOSPITAL MUNICIPAL MIGUEL COUTO. Oxygen therapy and non-invasive ventilation. Available in: . Accessed on 06 Jan 2020
- BELLO, Giuseppe; PASCALE, Gennaro; ANTONELLI, Massimo. Noninvasive Ventilation. Clinics in Chest Medicine. Vol. 37, n.4. 711-721, 2016
- KINNEAR, W. Non-invasive ventilation in acute respiratory failure. Thorax. Vol.57. 192-211, 2002
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