ISCCM Manual of Noninvasive Ventilation Yatin Mehta, Kapil Zirpe, Subhal Bhalchandra Dixit, Dhruva Chaudhry
INDEX
ABCDEFGHIJKLMNOPQRSTUVW
Page numbers followed by b refer to box, f refer to figure, fc refer to flowchart, and t refer to table.
A
Abrasions 85
Accessory muscle, use of 62, 67
Acidosis, severe 91
Acquired immunodeficiency syndrome 101, 149
Acute hypercapnic failure 78, 83
contributors of 82
Acute hypercapnic respiratory failure 51, 63, 77, 262
causes of 77
Acute hypoxemic respiratory failure 101, 113, 172, 262, 266, 269, 270, 276, 278, 280fc
treatment of 260
Acute left ventricle dysfunction 105
Acute respiratory acidosis 51, 143
prevention of 51
Acute respiratory distress syndrome 53, 54, 73, 96, 99, 113, 114, 116, 117fc, 176, 203, 270, 317, 321
de novo 115
development of 82
mild 63
mild-to-moderate 197
moderate-to-severe 183
severity of 115
Acute respiratory failure 3, 11, 41, 51-53, 62, 63, 63b, 67, 84, 98, 109, 119, 120, 142, 143, 149, 150, 153, 156, 159, 163, 183, 197, 210, 264, 269, 270, 317, 323
pathophysiology of 78, 145
Adaptive servo ventilation 20, 26, 128
Adequate monitoring, requirements for 198
Adequate oxygenation and ventilation 320
Adjuvant therapies 40
Adrenaline 47
Advanced airways, use of 316
Aerophagia 68
Aerosol delivery
device 46f
factors influencing 191f
Aerosol deposition 44, 44f, 188, 189f
Aerosol generator 44
types of 45, 192
Aerosol particles size 192
Aerosol system 188, 189
components of 188
factors determining efficiency of 188
Aerosol therapy 40, 43, 186, 188
common applications of 190, 190t
Agitation 79, 82
Air 275, 330
leak 42, 67, 86
compensation 15
pressure 86
Airway 53, 73, 190
clearance 311, 312
techniques 311
defects 307
diseases 74
dryness 57, 86
inflammation 190
injury 149
obstruction, respiratory depression 184
pressure 106f, 158
continuous 246
resistance 21
Alcohol intake 100
Allogeneic hematopoietic cell transplantations 101
Altitude compensation 132
Alveolar hypoventilation, primary 74
American thoracic society 11, 86, 157, 306, 307
clinical practice guidelines 216
Amikacin 190
Amphotericin B 190
Amyotrophic lateral sclerosis 74, 239, 245, 251
Ancillary therapies 311
Anesthesia 53
Anterior horn cell 73
Antibiotics 190
Anxiety 242
Aortic blood pressure 106f
Apnea 124
central 248, 254
hypopnea index 125, 248, 249
Apneic oxygenation, preprocedure 262
Argyle nasal prongs 290f
Arm edema 85
Arrhythmia 56, 59, 79, 102, 158, 167, 267
cardiac 261
Arterial blood gas 62, 67, 199
abnormalities 83
analysis 204, 204t
Arterial blood pressure 165
Arterial carbon dioxide 51
tension 78
Arterial oxygen partial pressure 40
Arterial pulse pressure 8
Aspergillus prevention 190
Asphyxia, less chances of 33
Aspiration 68, 167
high risk of 102
pneumonia 57, 85
risk of 58
worsening of 82
Asthma 73, 190, 322
acute 51, 52, 74, 190
severe 79
chronic obstructive pulmonary disease overlap syndrome 53
exacerbations 63
pathophysiological feature of 52
Asynchrony 32
Atelectasis 54, 121, 140, 146
bilateral lobar 121
preventing 276
treat postoperative 121
Atelectrauma 96
At-home ventilators 16f
Atrial natriuretic peptide synthesis 7
Automatic tube compensation 216
Auto-positive end-expiratory pressure 21
Auto-titrating continuous positive airway pressure 127, 129
Average volume assured pressure
mode 210
support 20, 23, 252
Awakening and breathing controlled trials 216
B
Backup respiratory rate 16, 251
Bag and mask, self-inflating 312
Bariatric surgery 120
Barotrauma 57, 59, 85, 96, 268
Becker's muscular dystrophy 134
Bernoulli's effect 289
Beta-agonists 190
Bilevel continuous positive airway pressure 297, 310
Bilevel noninvasive ventilation 51
Bilevel positive airway pressure 22, 23, 31, 40, 51, 64, 78, 101, 128, 129, 135, 241, 249, 317
spontaneous mode 20
therapy 302
work 108
Biotrauma 96
Biphasic positive airway pressure 316, 319
Bite plates 32
Biventricular function 6fc, 7fc
Blood
gas 70
analysis 199
worsening of 99
pressure, reduction in 125
products, large transfusion of 145
Blunt injury 99
Body mass index 83
Body weight, predicted 114
Borg dyspnea score 153
Borg scale, modified 153
Botulism 74
Boussignac continuous positive airway pressure 166f
mask 166f
Bowel obstruction 79
Brain injury, traumatic 313
Brainstem 91fc
Breath
enhanced jet nebulizer 46
per minute 252
stacking 140
Breathing
glossopharyngeal 136
measurement of 124
patterns 16
work of 21
British Thoracic Society 58
Guidelines 198, 225
Bronchial asthma
exacerbation of 85
severe 3
Bronchiectasis 73, 74, 78, 245
Bronchiolitis 22, 322
Bronchitis 74
Bronchodilator 45, 190
Bronchopulmonary dysplasia 245, 286, 310
Bronchoscopy 171
ultrasound guided 171
Bronchospasm 190
Bubble Continuous positive airway pressure system 288f
Bubble humidifier 43
Budesonide 47, 190
Bulbar involvement 253
Bulbar weakness 138
Burns 79
C
Capnography 203
mainstream 206, 206f, 206t
monitoring 203
waveform 204, 204f
understanding 204
Carbon dioxide 203, 205, 317
arterial partial pressure of 216
arterial pressure of 41
cutaneous 206
monitoring 247
rebreathing 57
transcutaneous measurement of 247
Cardiac arrest 56, 102
Cardiac disease 157
Cardiac failure 82
chronic 242
Cardiac function 105
Cardiac origin, pulmonary edema of 113
Cardiac output 105
Cardiac parameters 200
Cardiac transmural pressure 105, 108
Cardiogenic pulmonary edema 51, 52, 63, 74, 98, 105, 109, 157, 197, 259, 260
management of 10
pathophysiology of 10, 105
Cardiopulmonary disease 154, 157
Cardiopulmonary interactions 11
Cardiopulmonary monitoring 312
Cardiorespiratory interaction 107f
Cardiovascular system, effects on 7
Care providers, training of 312
Ceftazidime 190
Central inspiratory drive, inadequate 307
Central nervous system
abnormalities 74
diseases 73
Central sleep apnea 254
Central venous pressure 9
Chemotherapy, receiving 149
Chest
deformity, obese severe 27
trauma 53, 99, 142
non-flail 54
wall 74, 236
abnormalities 74
deformity 51, 55, 63, 65, 77, 85, 142, 143, 144t, 235
disease 74, 144
disorders 142, 235
trauma 74
X-ray 295
Cheyne-Stokes
breathing 26
respiration 254
Child's inspiration 289
Chronic end-stage diseases 242
Chronic home respiratory support 313
Chronic hypercapnic respiratory failure 89
management of 89
Chronic obstructive airway disease 74
Chronic obstructive pulmonary disease 3, 51, 63, 73, 77, 78, 89, 90, 96, 113, 138, 171, 179, 187, 190, 197, 210, 216, 218f, 233, 234, 236, 239, 240, 243, 245, 251, 259, 262, 267, 306
acute exacerbation of 51, 63, 74, 86, 89, 163
exacerbation 90f, 92fc, 190
stable 90f
Chronic obstructive pulmonary disorder 50
Chronic respiratory
conditions 233
diseases 306
failure 143, 179, 233, 235, 242, 306
support 306
Claustrophobia 33, 34, 36, 57, 82, 86, 102, 131
Colistin 190
Collection bag 46
Coma 56
Concurrent infection 78
Confusion 79
Consciousness
altered 93
impaired 56, 79, 102
Continuous capnography 208
use of 208
Continuous cardiorespiratory monitoring 320
Continuous flow devices 287, 288
Continuous positive airway pressure 3, 10, 13, 21, 40, 84, 97, 105, 108, 114, 119, 125, 127, 146, 150, 170, 186, 233, 241, 252, 259, 267, 285, 288f, 291, 292f, 295, 300, 317, 318
components of 287
delivery system, components of 287f
device 289f
failure of 293
fixed 127, 129
interfaces 291t
machines 310
principle of 286, 286f
role of 146
settings, adjustment of 292
types of 287, 287t
weaning from 293
Conventional bubble humidifier 264
Conventional invasive ventilation 113, 259
Conventional oxygen therapy 260, 261, 269, 270
Cor pulmonale 82
Corticosteroids 62, 149, 150
Cosmetic issues 131
Cough
assist device 253, 311
augmentation 253
impaired 138
reflex 146
Craniofacial anomalies 308
Critical care ventilator 66, 110
Cystic fibrosis 59, 245, 310-312
D
Daytime sleepiness, excessive 253
De Novo acute respiratory failure 51, 54
Dead space 31
ventilation 92
Deep sedation 184
Deep vein thrombosis 85, 214, 241
Delirium 178
Delivery devices 318
Delivery room continuous positive airway pressure during resuscitation 286
Denitrogenation 169
Deoxyribonucleotidase 312
Desynchrony, state of 85
Device criteria 240
Dexmedetomidine 184
Diabetes mellitus 105, 124
Diaphragm 53
movements of 5
Diaphragmatic dysfunction 96, 100, 119
ventilator-induced 176
Diaphragmatic pacing 313
Diaphragmatic rupture 74
Disposable vapor transfer cartridge 264
Disuse atrophy 74
Domiciliary noninvasive ventilation 239
Downes score system, modified 296t
Draeger nasal prongs 290f
Drug
class 190
dose inhaler 45
Dry mouth 82
Dry powder inhaler 47, 189
Duchenne muscular dystrophy 134, 239, 251, 253
Dynamic transpulmonary pressure 158
Dyslipidemia 124
Dyspnea 143, 153, 158
reduction of 153
relieves 103
Dystrophinopathies 134
E
Early mobilization, cost-effectiveness of 179
Early morning bifrontal headaches 253
Edema
acute cardiogenic pulmonary 96
fluid, leakage of 145
Effective aerosol drug delivery 189t
Ejection fraction, reduced 254
Electrocardiography, continuous 200
Electrolyte abnormalities 74
Emphysema 74
Encephalitis 73, 313
Encephalopathy
hypercapnic 91
persistent 82
End-expiratory lung volume 90, 125, 275
End-inspiratory transpulmonary pressure 158
Endocrine disorders 74
Endoscopic retrograde Cholangiopancreatography 172
Endoscopy 63, 172
Endotracheal intubation 3, 51, 62, 96, 98, 146, 183, 259, 317
preoxygenation before 267
required 101
Endotracheal tube 290f, 316
End-tidal capnography 205
End-tidal carbon dioxide 199, 204f
monitoring 204, 204t
Epoprostenol 190
Erectile dysfunction 125
Erythema 57, 85
Esophageal anastomosis, recent 56, 79
Esophageal balloon 158
European Pressure Ulcer Advisory Panel 224
European Respiratory Society 11, 86, 157, 216
Exacerbation, acute 51
Excessive leaks around mask 68
Exhalation valve, position of 16
Expiratory positive airway pressure 3, 13, 16f, 21, 41, 64, 78, 97, 108, 128, 135, 240, 243, 319
Extubation failure 216
high risk of 217
F
Face
injury 34
mask 96, 114, 234f, 254
simple 264
total 226, 237f
pressure sores on 82
Facial
burns 56
hair 131
skin lesions 85
trauma 56, 79, 99, 102
Fat embolism syndrome 73
Fatty acids, hyperoxygenated 226
Fiberoptic bronchoscopy 171
First line respiratory support 149
Fisher and Paykel nasal prongs 290f
Flail chest 53, 73, 74, 146
trauma 54
Flexible fiberoptic bronchoscope 171
Fluid
flip 289f
responsiveness, predicting 10
Fluticasone 190
Forced expiratory volume 53, 144
Forced vital capacity 144, 243
Free eyes 33
Free mouth 33
Full-face 32, 80, 109
mask 35, 36, 101, 236, 308
Full-night studies 129
Functional residual capacity 8, 97, 144
G
Gas exchange 146, 158
indices 144
parameters 198
Gas flows 16
Gastric
distension 33, 68, 200
insufflation 57, 86, 223, 228
Gastroesophageal reflux, symptoms of 125
Gastrointestinal effects 297
Gastrointestinal procedures 173
Gastroscopy 172
Glasgow coma
scale 50, 56, 83, 198, 239, 243
score 200
Glucose tolerance, impaired 124
Greater respiratory impairment 158
Guillain-Barré syndrome 73, 74, 313
H
Haloperidol 184
Head
and neck movements, restriction of 36
injuries 99
Headgear placement 131
Health evaluation, acute physiology and chronic 50, 54, 84
Heart 106
disease 323
failure 7, 254, 260, 267
acute decompensated 163, 262
congestive 21, 64, 254, 266
incidences 125
programs for 254
lung interaction 5, 11, 106, 108
clinical applications of 9
rate 295
Heat
advantages of 187t
and moisture exchanger 42t, 80, 186
filter 187, 189
disadvantages of 187t
Heated humidifier 41, 42t, 43, 187
systems 187t
Helium 35, 35f, 80, 190, 236, 237f
Helmet mask 101
Hematopoietic stem cell transplant 149, 150
Hemodynamic effects 59
Hemodynamic instability 56, 57, 79, 102, 116, 178
exclusion of 157
severe 79
Hemothorax 53, 54, 146
High dependency unit 63, 197
High flow nasal cannula 84, 170, 257, 259, 264, 266t, 267, 271, 275, 280fc, 301, 303, 304, 317, 320
administration of 303
delivery 303f
indications of 302
infection 262
oxygenation 259, 281
therapy 268, 275, 279, 304
heated humidified 300
High flow oxygen
group 115
therapy 264, 271
High oxygen requirement 255
Home bilevel positive airway pressure 245
Home care service 251
Home mechanical ventilation 252
indications of 245
Home noninvasive ventilation 235, 237, 245
Home oxygen therapy 252, 313, 314
Home respiratory support 306, 307t, 314b
indications of 307
part of 310
required 313
weaning of 313
Home ventilation 231, 233, 238, 245, 251, 252, 254, 307t
mainstay of 251
major indications for 251
require 307
Home ventilator 249
and telemonitoring, monitoring accuracy of 245
care 251
Hospital readmission, risk of 252
Hudson nasal prongs 290f
Humidification 40, 41, 131, 186, 188
device 311
types of 42
Humidified gas, warmed 266
Humidified oxygen, high flow 150
Humidity
absolute 41, 187
control of 227
Hybrid mask 237f
Hydration, adequate 235
Hydrogen peroxide 48
Hypercapnia 238, 252
chronic daytime 241
daytime 254
persistent 252
predominate 252
Hypercapnic failure 272
acute on chronic 83
moderate 272
Hypercapnic respiratory failure 113, 272
Hypercapnic subgroup 153
Hyperemia, local 247
Hypertension, chronic 105
Hypertonic saline therapy 312
Hypervolemia 9
Hypophosphatemia 215
Hypopnea 124, 248
Hypotension 57, 68, 85, 167
Hypoventilation 140, 172
alveolar 72, 73
central 245
chronic 143
congenital 313
severe central 308
syndrome 23
congenital 308
Hypoxemia 54, 73, 105, 143, 167, 252, 270
acute 100
cycle of 105
progressive 277
severe 79, 261
severity of 116
Hypoxemic acute respiratory failure 277
Hypoxemic respiratory failure 91, 96, 98, 101, 102fc, 103, 119, 146, 157, 235, 259, 260, 264, 267, 271
post-traumatic 147
preoxygenation in 271
Hypoxia 154, 172, 247
severe chronic 307
I
Ideal interface, characteristics of 30, 30b
Illness, acute 253
Iloprost 190
Infection
acute 312
control 48
Inflammatory cellular infiltrates 145
Influenza
A 54
H1N1 infection 158
severe 266
Inhaled gas
pressure of 42
temperature of 42
In-home titration 130
disadvantage of 130
Injury, diaphragmatic 100
Insomnia, severe 127
Inspiratory flow 15, 42
Inspiratory limb, single 278
Inspiratory oxygen fraction 40
Inspiratory positive airway pressure 3, 13, 16f, 21, 64, 78, 97, 108, 128, 145, 236, 240, 243, 251, 319
titration of 135
Inspiratory time 23
Inspiratory trigger 15
Inspired oxygen 259
ratio 115
fraction of 17, 42, 79, 96, 97, 179, 187, 264, 288, 295, 295f
Insufflation-exsufflation devices 253
Intelligent volume assured pressure support 20
ventilation 24
Intensive care unit 13, 17, 50, 63, 77, 96, 149, 159, 163, 177, 188, 197, 208, 216, 275, 300, 306
acquired weakness, management of 177
procedures 169
ventilators 16f, 17, 17t
Interface
change of 226
choice of 79
fit, proper 225
material, proper 225
types of 32, 190, 236
Interhospital transfer 163
Intermittent positive pressure ventilation 5
Internal flow sensors 294
Internal pneumatic stabilization 146
Intra-abdominal pressure 5
Intrahospital transfer 164
Intrathoracic pressure 5, 105
effects of 7fc
Intubation bundle 170
Invasive artificial airway 169, 233
Invasive mechanical ventilation 3, 50, 56, 77, 96, 99, 102, 113, 151, 159, 176, 242, 276, 317
complications of 149
postextubation from 55
weaning assist from 216
Invasive positive pressure ventilation 137
Invasive ventilation 13, 253, 259, 260, 306, 316
elective 141
Ipratropium 190
bromide 47
nebulization 62
Ischemia 59
cardiac 158
Isopropyl alcohol 48
J
Jacket ventilator 19
Jet nebulizer 45, 46
correct use of 47
types of 46
Jet reservoir 46
Jet turbine principle 166f
K
Kidney
disease, chronic 124
failure, chronic 105
Kussmaul's sign 9
Kyphoscoliosis 73, 74, 77, 85, 251
early-onset 245
Kyphosis 142
L
Lacrimation 33
Lactate dehydrogenase 158
Leak test 246
Left ventricle 6, 7, 8f
dysfunction development 105
Left ventricular
dysfunction 82
ejection fraction 261
end-diastolic
pressure 105
volume 9
Lethargy 143
Levosalbutamol 47
Limb
circuits, single 86, 251
expiratory 291
inspiratory 291
number of 246
Low intensity ventilator strategy 234
Low ventilatory support 313
Lower motor neuron 138
Lung 74, 106, 136, 245
abnormality 73
capacity, total 90
compliance 21
reduced 318
contusion 146
disease
acute interstitial 190
chronic 252, 302, 310
granulomatous 73
interstitial 310
failure 72
inflation of 7
injury 11
acute 114, 152
aggravating 114
ventilator induced 96, 156, 285, 323
parenchyma 53, 73, 145
acute infection of 156
severe infection of 156
resection
postoperative 120
sequelae 245
transplantation 121, 190
volume 5, 7
M
Machine 246
expiratory component 246
inspiratory component 246
unintentional leaks 246
Malignancy
advanced 242
hematologic 101, 266
Malnutrition 74
Mask
comfort 67
discomfort 68
intolerance 57
rotation 226
types of 101
Maximum expiratory pressure 144
Maximum inspiratory pressure 144, 243
Mean airway pressure 295
Mean blood oxygen 145
Mean systemic filling pressure 5, 6, 6f, 7
Mechanical ventilation 3, 98, 157, 214, 215f, 259, 260, 280, 295
delivery of 285
prolonged 215
Medicine, evolution of 245
Mental status 304
Metabolic acidosis 105
presence of 116
Metabolic substances, accumulation of 224
Metastatic pain, severe 153
Metered dose inhaler 45, 45f
Midazolam 184
Molecular genetic testing 134
Monitoring and nursing care 295
Monitoring and weaning 195
Monitoring parameters 198
Morphine 153, 184
Motor functions, normal 139
Motor neuron disease 245
Mouth breathing 131
Mouthpiece 32, 79
Movement disorders 127
Mucociliary clearance 100
Multicenter randomized controlled trial 119
Multidrug resistant 190
pneumonia 190
tracheobronchitis 190
Multiorgan dysfunction syndrome 203
Multiorgan failure 116
Muscle
abnormalities 74
strength
expiratory 253
inspiratory 253
Muscular dystrophy 74, 142, 245, 313
Musculoskeletal self-injury, risk of 178
Myasthenia gravis 74
Myocardial infarction 11
Myocardium 108
Myopathy 134
Myotrauma 96
N
Narcolepsy 127
Nasal airway resistance 42
Nasal antihistamines 131
Nasal bridge 110, 223f
ulceration 57
Nasal cannula 150, 264, 290, 300
and masks, normal 261
monitoring in high flow 275
physiological effects of high flow 275
role of high-flow 152
settings of high flow 278
set-up of high-flow 265f
success, predictors of high flow 276
therapy, newborn receiving high flow 303f
treatment failure, predictors of high flow 276
weaning from high flow 268, 275, 279
wide-bore 275
Nasal congestion 57, 68, 86, 131
Nasal continuous positive airway pressure 285, 301
contraindications 286
failure 293
indications 285
Nasal decongestants 235
Nasal dryness 68, 86
Nasal effects 297
Nasal glucocorticoids 131
Nasal high-frequency ventilation 285
Nasal interfaces 32, 33, 33f
types of 290f
Nasal mask 32, 36, 79, 101, 137, 237f, 289
Nasal mucosa, keratinization of 42
Nasal neurally adjusted ventilator assist 285
Nasal oxygen, high flow 218, 262
Nasal pillows 32, 79, 101, 131, 236, 237f
Nasal prongs 289, 308
secure fixation of 290f
Nasal sling 32
Nasal trauma 290f
scoring chart 292f
Nasogastric tube 227
insertion 57
Nasopharyngeal prong 290, 290f
single 290f
Nebulization 40
common drugs used for 47, 47t
Nebulizer 192
Negative pressure
pulmonary edema 10
ventilation 40
Neonatal intensive care unit 295
Neonates 285
Neonatology and pediatrics 283
Neuromuscular disease 33, 51, 55, 63, 65, 77, 85, 134, 235, 236, 240, 245, 249, 251, 253
inherited 253
Neuromuscular disorders 59, 74, 242
chronic 253
Neuromuscular junction 134, 136
Neuromuscular transmission 73
Neuromuscular weakness 149, 311, 312
Newborns, sample monitoring chart for 295f
Nocturnal arrhythmias 125
Nocturnal hypercapnia 134
Nocturnal hypoventilation 253
reduce 239
Noncardiogenic pulmonary edema 74
Noninvasive approaches, novel 136
Noninvasive high-frequency ventilation 20, 26
Noninvasive home ventilators 13
Noninvasive interfaces 36
Noninvasive positive pressure ventilation 40, 50b, 62, 113, 115, 119, 171, 191f, 285, 293
delivery 99
devices 294
failure of 295
nasal interface 294
settings, adjustment of 294
types of 317
Noninvasive pressure support ventilation 294
Noninvasive respiratory support 316
Noninvasive ventilation 3 5, 11, 13, 17t, 19, 30, 37, 50, 51b, 56, 56t, 62, 63b, 64, 70, 77, 83, 89, 91fc, 96, 97, 102b, 105, 110, 113, 114b, 119, 140, 149, 156, 163, 167t, 169, 173, 176, 183, 184t, 187t, 188, 190, 197, 203, 210, 211t, 217, 223, 234, 245, 251, 254, 259, 262, 266, 285, 295f, 300, 308, 319, 323
advantages of 4
adverse effects of 200
aerosol equipment for 44
ambulation on 176
and tracheostomy 218
application of 62, 65, 66, 66f, 69fc, 98, 109, 217
classification of 20fc
complications of 50, 57t, 297
contraindications of 50, 143, 317
discontinuation of 68
disease specific 75
duration, stepwise reduction in 211
during transport 163
evidence for 150
failure 82, 91, 92, 93, 156, 320, 322
higher risk of 151
predictors of 116, 158
reasons for 157
strategies to reduce 92
fate of 82
favor humidification during 186
humidification in 187
immediate withdrawal of 212
in abdominal surgery, role of 119
in atelectasis, role of 121
in bariatric surgery, role of 120
in hypoxemic respiratory failure, role of 103
in postlung transplant, role of 121
in spinal surgery, role of 120
in thoracic surgery, role of 120
including newer modes, modes of ventilation for 19
indications for 50, 90, 210, 317
initiation of 64
interface 30, 237
adopted 36
long-term 136, 233
management of 102fc, 318
mask 223f
mode 20fc, 210
ventilators without 17
monitoring of 67b, 197, 200
nebulizer in 192f
outcome, predictors of 140
physiological benefits of 97b, 97fc
place of 142, 143
position of 44
potential benefits of 113b
practical aspects of 109
predictors of 116b, 138
pressure support, stepwise reduction in 211
protocol for application of 64
rationale of 3, 4, 89, 96
reasons for underfeeding on 227
rherapeutic benefits of 144t
role of 98, 99, 135, 137, 140
sedation during 183
settings 144
setup 101
skin damage during 37f
spacer in 192f
strategy 285
success 320
therapy, complications of 85
troubleshooting of 68t
use of 4, 50, 117fc, 134, 233, 321
utilization of 216
ventilation in 144, 236
ventilators for 13
weaning from 210
Noninvasive ventilator 19, 20, 101, 165
understanding 14
Non-rebreathing reservoir mask 264
Normocapnic hypoxemia 143
Nosocomial infection, prevents 119, 316
Nosocomial pneumonia 85, 119
Novel techniques 140
Numeric rating scale 153
Nutrition 223, 227
O
Obesity 74, 77
hypoventilation syndrome 63, 65, 83, 120, 210, 241, 245, 251, 252
mild 252
Obstructive disorders
of upper airways 317
severe 247
Obstructive sleep apnea 22, 78, 82, 100, 120, 124, 125, 234, 235, 239, 241, 242, 245, 252, 269, 271
classification 124
goals of management 124
indications of 125t
modes of administration of 126, 126t
signs of 124t
symptoms of 124t
Onblanchable erythema 224
Ondine's curse 74
Opera trial 270
Operating room 163
Opioids 208
Oral airway 308
Oral dryness 68, 86
Oral interfaces 32, 32f, 131
Oral mask 236, 237f
Oral surgery especially soft palate 33
Organ dysfunction 83
major 158
Organ failure 157
extrapulmonary 114
life-threatening 56
presence of 270
Organ transplant 266
Organophosphate poisoning 74
Oronasal mask 34, 34f, 36, 101, 236, 237f, 318
Oropharyngeal airway 308
Orotracheal intubation 261
Orthopnea 254
Osserman classification, modified 137t
Osserman system, modified 136
Oximetry, continuous 67
Oxygen 40, 190, 208, 300
abnormalities of delivery of 74
administration of 157
arterial
partial pressure of 169
pressure 157
blender 275
cannula, standard 290
concentrator 233
conserver device 311
delivery devices 264
delivery system 259
flows 16
group 151, 153
heated humidified 275
inspiratory 157
saturation 154
source 233, 310
supplementation 269, 306, 310
supply 15, 169
therapy 10, 151, 300
long-term 235, 240, 243, 251
treatment, standard 280
wastage of 311
Oxygenation 40, 105
criteria 276
P
Pain, postoperative 53
Palliative care 51, 55, 153, 242
settings 153, 154
Pancreatitis, acute 145
Pandemic viral illness 54
Paralysis 261
Parasomnia 127
Parenchymal defect 307
Partial pressure of oxygen 79
Passover humidifiers 43
Patent ductus arteriosus 73
Patient education and monitoring 237
Patient selection prior to transport 164
Patient's mental status 102
Patient-device interface 130
Patient-ventilator
desynchrony 57, 86
interfaces 3
synchrony 67
Peak expiratory
flow rate 43
pressure 309
Peak inspiratory
flow rate 264
pressure 295f, 309
Pediatric acute lung injury consensus conference 321
Pediatric intensive care units 302
Pediatric settings, acute 317
Percutaneous gastrostomy 253
Perfusion inequality 72
Pericardial diseases 9
Phrenic nerve paralysis 245
Physical therapy 176
Physiological exchange parameters 198
Physiotherapy 223, 228
Pleural abnormalities 74
Pleural cavity abnormality 73
Pleural effusion 74
Pleural pressure 90, 106
Pneumatic jet nebulizer with reservoir tube 46
Pneumatic nebulizer 45
types of 46
Pneumoconiosis 73
Pneumonia 22, 54, 59, 63, 73, 74, 82, 96, 98, 146, 149, 156, 157, 316, 322
acute respiratory failure due to 157
community acquired 91, 156, 158, 159
incidence of 156, 261
management of 98, 156
mild-to-moderate 322
ventilator-associated 51, 96, 156, 197, 214, 259, 323
risk of 119
venturi mask for 157
Pneumothorax 53, 54, 73, 79, 82, 268
acute 56, 85
Poliomyelitis 74
Polymyositis 74
Poor cough 311
Poor nutritional status 100
Portable pressure ventilators 65
Portable ventilator 233
Positive airway pressure 125
amount of 128
modes of 126
therapy 125
initiation of 126
Positive end-expiratory pressure 3, 16, 16f, 58, 64, 67, 78, 96, 97, 108, 113, 149, 152, 156, 170, 184, 189, 191f, 259, 266, 286, 295
adequacy of 67
Positive pressure ventilation 7fc, 13, 136, 233
application of 89
Post-bariatric surgery 120
Post-brain injury sequelae 311, 313
Post-cardiac surgery 267
postextubation hypoxemia 262
respiratory failure 261
Post-cardiopulmonary resuscitation 267
Postextubation 51, 269, 270, 286, 293
failure 214
hypoxemia 262
respiratory failure 55, 63, 77, 83, 214
prevent 216
support 267
Preintubation
apneic oxygenation 261
oxygenation 63, 262
Premature extubation 214
Prematurity 74
apnea of 286, 293, 300, 302
Premorbid and comorbid state 83
Preoxygenation 169, 173, 269
Pressure
alveolar 105, 106f
areas, cushioning of 225
control 78, 167
expiratory 23
generating device 288
intrapleural 6, 7
ramp 132
relief 131
settings, selecting 128
sores 57, 68
measures to prevent 224
support 78, 97, 167
adequacy of 67
approach 66
ventilation 80
volume assured 20, 23
ulcers 85, 214, 223, 223f, 226f
stages of 224, 224f
ventilation, volume-targeted 23
Pressure-based trigger 19
Pressure-targeted modes 27
Pressurized metered dose inhaler 45, 189, 190, 191f, 192, 192f
Primary pathology permits 301
Procedural sedation 173
Progressive illness 313
Propofol 184
Proportional-assisted ventilation 20, 24
Prostaglandin synthesis 7
Protein loss 234
Protocolized spontaneous breathing trial 215f
Pseudohypertrophic muscular paralysis 134
Pulmonary arterial
hypertension 73
pressure 92, 144
Pulmonary capillaries 73
Pulmonary compliance 100
Pulmonary contusions 53
Pulmonary edema 73, 105
Pulmonary effects 297
Pulmonary embolism 9, 73, 214
Pulmonary fibrosis 73, 82, 154, 245
Pulmonary hypertension 190, 310
Pulmonary infiltrate, severity of 158
Pulmonary interstitial edema, mechanical effect of 106
Pulmonary vascular resistance 8
effects on 8
Pulmonary vasculature 53
abnormality 73
Pulse
oximeter 247, 312
oximetry 198
continuous 165
lowest 271
oxygen delivery system 311
pressure variation 8, 10
Pulsus paradoxus 9
reverse 9
Pump failure 72
Q
Quadriplegia 134, 138
R
Radiological atelectasis score 121
Randomized controlled trials 50, 52, 183, 216, 262, 270, 321
Rapid eye movement 127, 138, 247
Rapid shallow breathing index 199
Rebreathing 86
promote 110
Recurrent atrial fibrillation 125
Relative humidity 187, 264
Remifentanil 184
Residual volume 90
Respiration through mouth 33
Respiratory acidosis 304
acute on chronic 51
and lethargy 145
development of 52
Respiratory and cardiac muscles 134
Respiratory arrest 56, 79, 102, 267
Respiratory assist devices 251
Respiratory assistance 138
Respiratory comorbidities 137
Respiratory complications 139
Respiratory compromise 235
Respiratory disease 54, 87, 157, 304
Respiratory disorders 100
Respiratory distress 51, 67, 70, 153, 293, 301, 317
causes of 322
moderate-to-severe 62
score 322
severe 102
syndrome 285, 300
mild-moderate 304
Respiratory dysfunction 145
Respiratory effort
absence of 248
related arousal 125
Respiratory failure 51, 52, 54, 72, 73t, 74t, 96, 100, 134, 142, 217, 218f, 268, 276, 300, 370
anticipated 300
causes of 73t
mechanism underlying 142
perioperative 100
physiology of
type I 72
type II 72
postoperative 63, 119
profound 134
risk of severe 275
severe 98
acute 157
type I 72
type II 73, 234
Respiratory function 135, 259
Respiratory impairment
signs of 253
symptom of 253
Respiratory insufficiency, mechanism of 307
Respiratory mechanics 144
Respiratory muscle 52, 134
diseases of 73
dysfunction 234
fatigue 4, 149
mechanical failure, sign of 106
Respiratory pump, inadequate 307
Respiratory rate 62, 67, 83, 248, 269, 277, 278, 313
analysis 248
higher 270
oxygenation index 277
reduced 272
Respiratory secretions, excessive 79
Respiratory stimulation 247
Respiratory support
adequacy of 312
advancements in 134
equipment for 309
long-term 306
mode of 134
Respiratory system, compliance of 91
Respironics BiPAP vision 15
Restrictive disease 27
Restrictive disorders 247
Restrictive thoracic disorders 85, 144
Rib fractures 53
Right atrial pressure 5, 6, 6f, 7, 9
Right ventricle 6, 7, 8f
Right ventricular
dysfunction 82
end-diastolic volume 8f
failure 190
Rigid bronchoscope 171
Risperidone 184
S
Salbutamol 47, 62, 190
Salivation 33
Salmeterol 190
Salt and water retention 4 7
Scleroderma 74
Scoliosis 142
Second-generation systems 248
Secretion
accumulation of 92
clearance 200
drying up of 82
Sedation 184, 261
drugs used for 183, 184t
indications for 183
practices 183
related issues 59
Seizures 184
Sensorium 67
worsening of 70
Sepsis 74, 156
Series effect 8
Shock 145, 267
circulatory 74
Shunt 146
Sickle cell disease 310
Sidestream capnography 206, 206f, 206t
with nasal prongs, use of 207f
Silverman-Anderson scoring system 296t
Six-minute walk test 254
Skeletal muscle weakness 136
Skin
damage 34
lesions 223
rash 57
sores 223
Sleep
architecture, impaired 249
disordered breathing 254, 310
hypoventilation 247
sudden awakenings from 253
Sleepiness, daytime 125
Small volume nebulizer 43, 45, 46t
Sniff nasal
inspiratory pressure 241
pressure 236
Solid organ transplant 149, 150
Solid tumors 153
Spanish sleep network study 252
Spinal cord
damage 245
injury 139
level of 139t
trauma 73
Spinal injury, acute phase of 139
Split-night studies 130
Spontaneous awakening trials 216
Spontaneous breathing 43, 247
effects of 6fc
nebulization during 44f
trials 215, 218f
Spontaneous respiration 106
cardiovascular effects of 107
Status asthmaticus 9
Sterile water reservoir 264
Stress
extramural 106f
intramural 106f
Stroke 73
volume variation 8, 10
Sudden heart failure 105
Supplemental oxygen 40, 261
Support staff, training of 301
Surgery, abdominal 53
Surrogate 158
Symptomatic sleep 254
Synchronicity 248
Synchronized noninvasive positive pressure ventilation 294
Systemic lupus erythematosus 74
Systemic vascular resistance 105
Systolic pressure variation 8, 10
T
Tachycardia 85
Tachypnea 70
Tank ventilators, development of 19
Telemonitoring 248
Temperature 279
Terbutaline 47
Tetanus 73
Tetraparesis, causes of 139t
Tetraplegia 36, 134, 138, 139, 140t
causes of 139t
Therapy
monitoring of 82
titration of 81, 312
Third-generation systems 248
Thoracic cage abnormalities 245
Thoracoabdominal asynchrony 277
Thoracoabdominal dyssynchrony 304
Thoracoplasty 74, 142
Thoracotomy 140
Tidal breathing 90f
Tidal volume 20, 67, 90, 92
monitoring 36
Tiotropium 190
Tissue ischemia 105
local 224
Titration modality 129
Tobramycin 190
Tolerate oronasal masks 318
Tracheobronchomalacia 172
Tracheostomy 214, 308
care 311
tube 251, 254, 316
Traditional capnography 205
Traditional oxygen devices 264
Transcutaneous capnometry monitoring 208
Transcutaneous carbon dioxide 199
monitoring 207
Transdiaphragmatic pressure 144
Transesophageal echocardiography 172
Translate sound 234
Transport, preparation for 165
Transverse myelitis 73
Trauma 51, 53, 63, 73, 145
local 268
management 146
Trigger 19
sensitivity 319
Two finger rule 225f
U
Ultrasonic nebulizer 45, 47
Uncooperative patient (confused, agitated) 56
Upper airway 143, 311
collapse 271
obstruction 56, 74, 102
fixed 79
patency of 100
surgery 79
Upper gastrointestinal tract surgery 143
Upper motor neuron 138
Upper respiratory tract 186
V
Vapor transfer cartridge 264
Variable flow devices 287, 288
Vascular problems defect 307
Vasoactive agents 190
Vena cava
inferior 10
superior 10
Venous return 5
Vented masks, use with 166
Ventilation 72, 92, 97, 251, 260, 308
alveolar 4, 24
effectiveness of 312
homogenous distribution of 269
intermittent mandatory 146
mode of 64, 190
volume-targeted 20
perfusion
inequalities 97
mismatch 234
pressure-targeted 21
strategy 235
via tracheostomy 251
volume-targeted 15
Ventilator 236, 288f, 309
alarms 312
and respiratory muscle pressure 158
circuit, device in inspiratory limb of 45f
dysfunction 312
dyssynchrony 58
failure 140
free days, terms of 114
interface 233
mode of 43
recent 24
selection of 236
parameters 67, 189
pressures 45
related factors 190
settings 247
tolerance of 67
type of 42, 110
Ventilatory assist, neurally-adjusted 20, 25, 216, 294
Ventilatory control center 89, 91fc, 92
Ventilatory failure 253
Ventilatory parameters 199
Ventilatory settings 16
Ventilatory support 245
Ventilatory technique 36
Ventricular function 6
Ventricular interdependence 5, 8, 9f
Venturi mask 264
Vibrating mesh nebulizer 189, 190
Viral illness 51
Viral pneumonias 3
Vital capacity, waning 134
Vocal cords 259
Volume assist-control mode 20
Volutrauma 96
Vomiting 33, 34, 56
severe 79
W
Weaning 63, 69
failure 214
noninvasive ventilation, strategies for 211
pulmonary edema of 11
×
Chapter Notes

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ISCCM Manual of Noninvasive Ventilation
ISCCM Manual of Noninvasive Ventilation
Editors Subhal Bhalchandra Dixit MD IDCCM FICCM FICP FCCM Consultant Critical Care and Director ICU Department of Critical Care, Sanjeevan and MJM Hospitals Pune, Maharashtra, India Dhruva Chaudhry MD (Med) DNB (Med) DM (PCCM) Senior Professor and Head Department of Pulmonary and Critical Care Medicine Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences Rohtak, Haryana, India Yatin Mehta MD MNAMS FRCA FAMS FIACTA FICCM FTEE Chairman Institute of Critical Care and Anesthesia Medanta—The Medicity Gurugram, Haryana, India Kapil Zirpe MD FICCM FCCM Director Neuro Trauma Unit Ruby Hall Clinic Pune, Maharashtra, India Foreword Shirish Prayag
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ISCCM Manual of Noninvasive Ventilation
First Edition: 2020
9789389776423
Printed at:
Editors
Subhal Bhalchandra Dixit
MD IDCCM FICCM FICP FCCM
Consultant Critical Care and Director ICU
Department of Critical Care
Sanjeevan and MJM Hospitals
Pune, Maharashtra, India
Dhruva Chaudhry
MD (Med) DNB (Med) DM (PCCM)
Senior Professor and Head
Department of Pulmonary and Critical Care Medicine
Pandit Bhagwat Dayal Sharma Postgraduate
Institute of Medical Sciences
Rohtak, Haryana, India
Yatin Mehta
MD MNAMS FRCA FAMS FIACTA FICCM FTEE Chairman
Institute of Critical Care and Anesthesia
Medanta—The Medicity
Gurugram, Haryana, India
Kapil Zirpe
MD FICCM FCCM
Director
Neuro Trauma Unit
Ruby Hall Clinic
Pune, Maharashtra, India
Section Editors
Bharat Jagiasi MD IDCCM
Head
Department of Critical Care
Su'asth Healthcare India Ltd
Mumbai, Maharashtra, India
Khalid Ismail Khatib MD FICCM
Professor
Department of Medicine
Smt Kashibai Navale Medical College
Pune, Maharashtra, India
Gunjan Chanchalani MD FNB IFCCM EDIC
Chief Intensivist
Department of Critical Care Medicine
Bhatia Hospital
Mumbai, Maharashtra, India
Banani Poddar MD (Pediatrics) DNB (Pediatrics)
Professor
Department of Critical Care Medicine
Sanjay Gandhi Postgraduate Institute of Medical Sciences
Lucknow, Uttar Pradesh, India
Neonatology and Pediatrics Section
Contributors Foreword
It gives me a great pleasure to write this foreword for the ISCCM Manual of Noninvasive Ventilation (NIV).
We are all aware of the great strides taken by the science of mechanical ventilation of the critically ill patients. From just being a machine being used to support failing respiratory system in 1950s, the science of this field has come a long way. Among the important strides being taken have been the ones associated with noninvasive ventilation.
The evolution of noninvasive positive pressure ventilation over the last 20 years has been quite enormous and interesting. It has started from the need to reduce the chances of ventilator associated pneumonitis with reducing the tracheal invasion during mechanical ventilation. It started with attempted use during various situations requiring mechanical ventilation for a short period of time. It has now evolved into two distinct categories of uses: one in the ICU or hospital as a substitute for invasive ventilation for conditions which are not so severe. The second category is the use at home for chronic long-term support.
Both these uses need their own detailed discussion in terms of conditions and stages in which to use, equipment, monitoring, complications and many other aspects.
This is the basic need for a workbook like this one being brought out by ISCCM.
The readers will be very attracted to the long list of topics included in this book and their curiosity and appetite will be whetted by this interesting list of contents.
I sincerely hope that the book meets the reader's expectations and adds laurels to the long list of achievements of ISCCM. I also hope that the dissemination of science of noninvasive ventilation leads to a more appropriate, scientific use of this equipment in the field of critical care.
Shirish Prayag MD FCCM
Shree Medical Foundation
Prayag Hospital
Pune, Maharashtra, India
Preface
Noninvasive ventilation (NIV), as a technique/intervention, is universally practiced by pulmonologists, intensivists, emergency physicians and anesthesiologists in different environments in varied conditions. Its use has expanded multifold over the years because of ease of application, cost effectiveness and flexibility. Indications have expanded, technology has improved leading to application of complex modes including dual modes, interface quality and choices have also improved thereby simplifying the application of technique. However, as a spin off, these added to the complexity, especially in view of choices of technology for delivery (ICU ventilators versus standalone NIV ventilators or by ventilators developed for home ventilation), how to optimize oxygenation and which mask (interface) to use to take care of patient's comfort with minimal leaks to maintain efficiency of ventilation. Noninvasive ventilations wider application lead to realization of limitation of the technique and potential harm. Practitioners frequently wonder how to nebulize, humidify the gas, correct patient ventilator asynchrony and use of sedation. Because of inherent reluctance for intubation, NIV is frequently used for prolonged periods in acute settings contributing to mortality and morbidity.
The ISCCM, the force and motivation behind the spread of critical care as a subspecialty in India, constituted a task force to relook at its previous guidelines on NIV in view of advances and new knowledge accumulated over the period under Dr Subhal Dixit and Dr Rajesh Chawla. During the formation of guidelines, it was realized that though there is an abundance of literature, but there is no Indian manual/monograph on noninvasive ventilation to guide the practitioners of this technique in the country, leading to concept and writing of this manual. There are 41 chapters in the manual under different section heads dealing with physiology, clinical applications, use in different types of respiratory failure, including end of life situations, and limitations, challenges as well as its use in pediatrics.
The editorial board is thankful to all the authors who have contributed in writing the chapters and sharing their knowledge and experiences. Dr Bharat Jagiasi, Dr Gunjan Chanchalani, Dr Khalid Ismail Khatib and Prof Banani Poddar deserve a special reference and thanks for their tireless work in helping shape the book in current format. We also extend our thanks to M/s Jaypee Brothers Medical Publishers, New Delhi, India, for ensuring the timely completion and publication of this manual.
Dhruva Chaudhry
on Behalf of Editorial Board
ISCCM Manual of Noninvasive Ventilation
Acknowledgments
As, President of Indian Society of Critical Care Medicine (ISCCM), it is my proud privilege to introduce the book ISCCM Manual of Noninvasive Ventilation to the critical care community.
With the ever-expanding field of critical care, an endeavor to strengthen the academics and ICU practices across the country, the ISCCM has come up with this book to serve as a bedside reference guide.
Noninvasive ventilation is the most popular way patients are ventilated in critical care units and its utility and indications have been well defined and accepted.
Experts from across the country have come together through the book to share their wide evidence based literature and knowledge in the field of noninvasive ventilation.
All the contributors are renowned critical care experts from leading institutions across India.
This book represents an invaluable resource for critical care professionals, and covers the full spectrum of noninvasive ventilation.
Intensivists, postgraduates across the country will find this book an invaluable reference text.
I would like to congratulate the Section Editors, Dr Khalid Ismail Khatib, Dr Bharat Jagiasi, Dr Gunjan Chanchalani and Dr Banani Poddar, on accomplishing the difficult task successfully.
I hope the book serves the purpose for critical care community in saving lives!
Best Wishes!!
Subhal Bhalchandra Dixit
MD IDCCM FICCM FCCM FICP
President ISCCM
2019-2020