Care and Management of a Patient Requiring Non-Invasive Ventilation (NIV) 

1. Patient Assessment and Preparation 

Indications for NIV 
Acute exacerbation of COPD 
Cardiogenic pulmonary oedema 
Hypoxemic or hypercapnic respiratory failure 
Obstructive sleep apnoea 

Contraindications 
Reduced consciousness/uncooperative patient 
Facial trauma or recent upper airway surgery 
Excessive secretions, vomiting, or high aspiration risk 
Pneumothorax without an appropriately sited chest drain. 

Baseline assessment 
Respiratory rate, SpO₂, ABGs 
Level of consciousness (GCS) 
Hemodynamic stability (BP, HR) 

Patient education 
Explain purpose and benefits of NIV 
Reassure patient to reduce anxiety and improve compliance 

2. Equipment and Interface Management 

Select appropriate interface 
Nasal mask, oronasal (full-face) mask, or helmet
 
Ensure proper mask fitting 
Avoid excessive tightness to prevent pressure sores 
Minimize air leaks 

Check ventilator settings 
Mode (e.g., CPAP, BiPAP) 
IPAP/EPAP or PEEP as prescribed 
FiO₂ adjusted to maintain target SpO₂ (as directed by the clinician) 

3. Ongoing Monitoring 

Respiratory monitoring 
Respiratory rate and effort 
Use of accessory muscles 
Breath sounds 
Chest rise symmetry 
 
Oxygenation and ventilation 
Continuous SpO₂ monitoring 
Repeat ABGs to assess response 

Patient tolerance 
Comfort, anxiety, mask intolerance 
Synchrony  

Vital signs 
Heart rate, blood pressure, temperature, respiratory rate, oxygen saturations 

4. Nursing Care and Support 

Skin care 
Inspect nasal bridge and face regularly 
Use protective dressings if needed to protect pressure areas (example, duoderm thin) 

Airway care 
Encourage coughing 
Gentle suctioning if required (a nasopharyngeal airway can be helpful) 

Hydration and nutrition 
Ensure adequate fluids 
Coordinate breaks from NIV (if safe) 

Positioning 
Semi-Fowler’s or upright position to improve ventilation; or lateral side lying in cases where one lung is more consolidated than the other (V/Q matching) 

Psychological support 
Reassurance and calm environment 
Address claustrophobia or anxiety 

5. Prevention and Recognition of Complications
 
Common complications 
Skin breakdown 
Gastric distension 
Dry mouth, nasal congestion 
Eye irritation from air leaks 

Signs of NIV failure 
Worsening hypoxia or hypercapnia 
Increasing respiratory distress 
Decreased level of consciousness 
Haemodynamic instability 
➡Escalate care promptly (consider intubation and invasive ventilation) 

6. Weaning and Discontinuation 
Gradual reduction in NIV support as condition improves 
Monitor closely for any deterioration during breaks from NIV 
Discontinue when: 
Respiratory distress resolves 
ABGs stabilize 
Patient maintains adequate oxygenation on low-flow oxygen 

7. Documentation 
Indication for NIV 
Ventilator settings and changes 
Patient response and tolerance 
Complications