Algorithm for the Use of NIV in Acute Exacerbations of COPD - Flowchart
Algorithm for the Use of NIV in Acute Exacerbations of COPD - Flowchart Algorithm for the Use of NIV in Acute Exacerbations of COPD Algorithm for the Use of NIV in Acute Exacerbations of COPD
Flowchart

INDICATIONS FOR IV


    pH < 7.35 and PaCO2 >6.0 kPa despite maximal medical therapy
    Able to protect airway
    Able to co-operate with treatment

INDICATIONS FOR IV


    pH < 7.35 and PaCO2 >6.0 kPa despite maximal medical therapy
    Able to protect airway
    Able to co-operate with treatment

INDICATIONS FOR IV

INDICATIONS FOR IV

    pH < 7.35 and PaCO2 >6.0 kPa despite maximal medical therapy
    Able to protect airway
    Able to co-operate with treatment

pH < 7.35 and PaCO2 >6.0 kPa despite maximal medical therapy 2
Able to protect airway
Able to co-operate with treatment

Most likely to benefit from NIV


    Consider contraindications (Table 1)
    Determine ceiling of care
    Appropriate setting and monitoring

Most likely to benefit from NIV


    Consider contraindications (Table 1)
    Determine ceiling of care
    Appropriate setting and monitoring

Most likely to benefit from NIV

Most likely to benefit from NIV

    Consider contraindications (Table 1)
    Determine ceiling of care
    Appropriate setting and monitoring

Consider contraindications (Table 1)
Determine ceiling of care
Appropriate setting and monitoring

End

End

End

pH < 7.35, >7.25

pH < 7.35, >7.25

pH < 7.35, >7.25

pH < 7.25

pH < 7.25

pH < 7.25

Ventilator set-up


    Initial settings IPAP 10, EPAP 4 cm H2O
    Aim for target IPAP of 20 cm H2O or until therapeutic response achieved
    Full-face mask for at least 24 hours
    Entrain oxygen to achieve SaO2 88-92%
    Continue nebulised therapy
    Check patient comfort and synchrony

Ventilator set-up


    Initial settings IPAP 10, EPAP 4 cm H2O
    Aim for target IPAP of 20 cm H2O or until therapeutic response achieved
    Full-face mask for at least 24 hours
    Entrain oxygen to achieve SaO2 88-92%
    Continue nebulised therapy
    Check patient comfort and synchrony

Ventilator set-up

Ventilator set-up

    Initial settings IPAP 10, EPAP 4 cm H2O
    Aim for target IPAP of 20 cm H2O or until therapeutic response achieved
    Full-face mask for at least 24 hours
    Entrain oxygen to achieve SaO2 88-92%
    Continue nebulised therapy
    Check patient comfort and synchrony

Initial settings IPAP 10, EPAP 4 cm H2O 2
Aim for target IPAP of 20 cm H2O or until therapeutic response achieved 2
Full-face mask for at least 24 hours
Entrain oxygen to achieve SaO2 88-92% 2
Continue nebulised therapy
Check patient comfort and synchrony

Assess response to NIV


    Check patient comfort and synchrony
    Check for mask leaks
    ABG 1 hour after initial set-up and any change in settings
    Escalation to intubation and invasive mechanical ventilation, where appropriate, if inadequate response to NIV

Assess response to NIV


    Check patient comfort and synchrony
    Check for mask leaks
    ABG 1 hour after initial set-up and any change in settings
    Escalation to intubation and invasive mechanical ventilation, where appropriate, if inadequate response to NIV

Assess response to NIV

Assess response to NIV

    Check patient comfort and synchrony
    Check for mask leaks
    ABG 1 hour after initial set-up and any change in settings
    Escalation to intubation and invasive mechanical ventilation, where appropriate, if inadequate response to NIV

Check patient comfort and synchrony
Check for mask leaks
ABG 1 hour after initial set-up and any change in settings
Escalation to intubation and invasive mechanical ventilation, where appropriate, if inadequate response to NIV

Failure of NIV


    Persistent respiratory acidosis
    Reduced respiratory effort/fatigue
    Reduced level of consciousness
    Inability to protect airway

Failure of NIV

Failure of NIV

    Persistent respiratory acidosis
    Reduced respiratory effort/fatigue
    Reduced level of consciousness
    Inability to protect airway

Persistent respiratory acidosis
Reduced respiratory effort/fatigue
Reduced level of consciousness
Inability to protect airway Failure of NIV

Successful NIV

Initiate weaning from NIV

Successful NIV

Successful NIV

Initiate weaning from NIV

Successful NIV

Consider NIV as ceiling of care or palliation

Consider NIV as ceiling of care or palliation

Consider NIV as ceiling of care or palliation

Intubation and invasive mechanical ventilation

Intubation and invasive mechanical ventilation

Intubation and invasive mechanical ventilation

For intubation

For intubation

For intubation

Not for intubation

Not for intubation

Not for intubation

Consider immediate intubation
Delayed intubation may lead to increased mortality
A trial of NIV may be an option, but in a critical care environment where rapid intubation is possible
Urgent critical care opinion should be sought

Consider immediate intubation
Delayed intubation may lead to increased mortality
A trial of NIV may be an option, but in a critical care environment where rapid intubation is possible
Urgent critical care opinion should be sought

Consider immediate intubation
Delayed intubation may lead to increased mortality
A trial of NIV may be an option, but in a critical care environment where rapid intubation is possible
Urgent critical care opinion should be sought

Consider immediate intubation


Urgent critical care opinion should be sought

For intubation

For intubation

For intubation

Not for intubation

Not for intubation

Not for intubation