Non Invasive Ventilation – Overview 

1. Types of Non-Invasive Ventilation (NIV) 

CPAP (Continuous Positive Airway Pressure): Provides constant positive pressure throughout the respiratory cycle to keep airways open. 

BiPAP / BIPAP (Bilevel Positive Airway Pressure): Provides two levels of pressure – higher during inspiration (IPAP) and lower during expiration (EPAP). 

Pressure Support Ventilation (PSV): Patient-initiated breaths are supported with preset pressure. 

Volume-targeted NIV: Delivers a set tidal volume using non-invasive interface. 

2. Explanation of NIV Terms 

PEEP (Positive End-Expiratory Pressure): Pressure maintained in the lungs at the end of expiration to prevent alveolar collapse and improve oxygenation. 

IPAP (Inspiratory Positive Airway Pressure): Higher pressure applied during inspiration to assist ventilation and reduce work of breathing. 

EPAP (Expiratory Positive Airway Pressure): Lower pressure during expiration that keeps airways open and improves oxygenation. 

CPAP: A single continuous pressure applied during both inspiration and expiration; improves oxygenation but does not directly support ventilation. 

BiPAP / BIPAP: A bilevel system combining IPAP and EPAP to improve both ventilation and oxygenation. 

3. Patient Assessment and Preparation 

Assess indications such as COPD exacerbation, pulmonary oedema, respiratory failure 
Identify contraindications (reduced consciousness, facial trauma, vomiting) 
Record baseline vitals, ABGs, SpO₂ 
Explain procedure to patient to reduce anxiety 

4. Equipment and Interface Management 

Select appropriate mask (nasal, oronasal, full-face) 
Ensure proper fit to avoid leaks and pressure sores 
Check ventilator mode, pressures, alarms, and FiO₂ 

5. Monitoring and Ongoing Care 

Monitor respiratory rate, effort, and chest movement 
Continuous SpO₂ monitoring and repeat ABGs as ordered 
Assess patient comfort and ventilator synchrony 
Monitor vital signs regularly 

6. Complications and NIV Failure 

Skin breakdown, pressure sores, nasal dryness 
Gastric distension and risk of aspiration 
Eye irritation from mask leaks 
Signs of NIV failure: worsening hypoxia, hypercapnia, decreased consciousness 

7. Weaning and Documentation 

Gradually reduce pressure support as patient improves 
Monitor tolerance during breaks from NIV 
Document indication, settings, patient response, and complications