Noninvasive Ventilation Mukesh Kumar Agarwal
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1Noninvasive Ventilation Made Easy®2
3Noninvasive Ventilation Made Easy®
Mukesh Kumar Agarwal MBBS MD DNB (Respiratory Diseases) Senior Consultant Pulmonologist Yashoda Group of Hospitals NCR, Ghaziabad, UP, India
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Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Noninvasive Ventilation Made Easy®
© 2011, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication and DVD ROM should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition: 2011
9789350250303
Typeset at JPBMP typesetting unit
Printed at5
To My loving wife Smita and my affectionate daughter Sadhvi who have supported me in this endeavor
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7Preface
Noninvasive ventilation is a method of ventilatory support without using endotracheal tube or tracheostomy tube. It is not an alternative to conventional invasive ventilation but has emerged as a useful method to give ventilatory support in many patients. It can be tried before intubation to obviate the need of invasive ventilation in appropriate patients.
The book is written with the aim to provide simple, practical and clinically useful text to readers. The book will be useful to physicians, pulmonologists, intensivists, paramedical staff involved in critical care practice and medical students.
This book is a focused, practical and concise text on noninvasive ventilation. I have tried to present the text in easily understandable manner. It is by no means a complete textbook or comprehensive standards of care document on noninvasive ventilation.
There is plenty of literature on invasive mechanical ventilation; however, relatively lacking of text prevails on noninvasive ventilation. I have tried to touch most topics related to noninvasive ventilation. With the help of available literature and personal experience on noninvasive ventilation, every effort has been made to put the subject in a simplified way. Main emphasis has been given on practical aspects. Lengthy theoretical details, surveys, trials and studies are omitted. Only relatively well-established aspects are covered.8
Purpose of text, clinical pearls, in a nutshell have been added to most of chapters. Much of the text is covered using tables and diagrams for purpose of ease.
A complete chapter has been devoted on IPAP, EPAP and CPAP. Starting NIV has also been dealt with in a separate chapter. Application of noninvasive ventilation in chronic conditions and non-pulmonary conditions has also been covered. The chapter on selection of best NIV equipment will help the buyer. General considerations have been covered in the last chapter.
Mukesh Kumar Agarwal
9Acknowledgments
I am thankful to Dr Dinesh Arora and Mr PN Arora of Yashoda Group of Hospitals NCR, Ghaziabad for their institutional encouragement. I am also thankful to Dr Arvind Sharma of same hospital.
I am also thankful to Mr Sandeep Malhotra of Genesys for his help and understanding. I am also thankful to Mr Ajay Billa of Genesys. I am also thankful to Mr Subhanshu and Mr Niranjan Sharma.
Last but not least, I am thankful to Mr Tarun Duneja and Mr Subrato Adhikary of M/s Jaypee Brothers Medical Publishers (P) Ltd, for their constant encouragement.
I am thankful to my esteemed teachers Dr BK Khanna, Dr MS Agnihotri, Dr PK Mukherjee, Dr Jitendra Nath and Dr Rajendra Prasad who have taught me the basics of Pulmonology.
I am thankful to my students who have given me the stimulus to read.
Acknowledgments will be incomplete without giving special thanks to all the workers who contributed in the field of noninvasive ventilation.
Acknowledgments will also be incomplete without giving special thanks to my parents, Mr Kamal Prasad Agarwal and Late Mrs Shanti Devi.
13Abbreviations ABG
Arterial Blood Gases
AHI
Apnea−Hypopnea Index = Total apneas + Total Hypopneas / Duration of sleep in minutes × 60
AI
Arousal Index = Total arousals / Duration of sleep in minutes × 60
BiPAP
Bi level Positive Airway Pressure
BPM
Breaths Per Minute
CMV
Controlled Mandatory Ventilation
CO2
Carbon dioxide
COPD
Chronic Obstructive Pulmonary Disease
CPAP
Continuous Positive Airway Pressure
CSA
Central Sleep Apnea
DMD
Duchene Muscular Dystrophy
EDS
Excessive Day time Sleepiness
EPAP
Expiratory Positive Airway Pressure
ETCO2
End Tidal Carbon dioxide
FiO2
Fraction of oxygen in inspired air
ICU
Intensive Care Unit
IPAP
Inspiratory Positive Airway Pressure
IPAP Max
Maximum inspiratory time, ventilator spends on IPAP14
IPAP Min
Minimum inspiratory time, ventilator spends on IPAP
IV
Invasive Ventilation. Ventilatory support with help of endotracheal tube or tracheostomy tube
LTV
Long Term Ventilation. Constant requirement of ventilator for more than three months after patient has become medically stable.
MV
Minute Ventilation
NIV
Noninvasive ventilation. Ventilatory support without help of endotracheal tube or tracheostomy tube. Interface is used instead.
NPPV/NIPPV
Noninvasive Positive Pressure Ventilation
O2
Oxygen
OSA
Obstructive Sleep Apnea
OSAS
Obstructive Sleep Apnea Syndrome
PaCO2
Arterial Carbon dioxide
PaO2
Arterial Oxygen
PC
Pressure Control
PEEP
Positive End Expiratory Pressure
PS
Pressure Support
SaO2
Oxygen Saturation
SIMV
Synchronized Intermittent Mandatory Ventilation15
T tot
Total Respiratory Cycle Time
Ti
Inspiratory Time
TV
Tidal Volume
UARS
Upper Airway Resistance Syndrome
Ventilatory dependency
Constant requirement of ventilator to maintain normal or near normal arterial blood gases and stable health
VS
Ventilatory support. Support of Respiration by Mechanical aids. Ventilatory support excludes use of supplemental oxygen alone without mechanical aid.
WOB
Work of Breathing