VENTILASI

NONINVASIF

Putu Andrika
 Overview

Mechanical ventilation is the most widely

used supportive technique in icu
Complications associated with endotracheal
intubation
Evidence demonstrating that noninvasive
ventilation (NIV)
decrease dyspnea and work of breathing,
improve gas exchange and
An integral tool in the management
of both acute and chronic
respiratory failure, in both the
home setting and in the critical
care unit.
Flexibility, valuable complement in
patient management.
Respiratory distress
Clinical signs include dyspnea,
tachypnea, and the use of accessory
muscles of respiration.
arterial blood gas may reveal acidemia
(arterial pH, <7.35), hypercapnia (partial
pressure of carbon dioxide [Paco2], >45
mm Hg), or hypoxemia (e.g., ratio of the
partial pressure of arterial oxygen [Pao2]
to the fraction of inspired oxygen [Fio2],
<200).
ARF
 Definition NIV

refers to  the  delivery of mechanical 

ventilation the lungs  using techniques 
that do not  require an  invasive artificial 
airway (ETT, TT)
INTERFACE

Baptista FA et al. Emergencias 2009;21:189-202

Cordova F et al. Non Invasive Mechanical Ventilation, 2010
Mechanism of action

Reduction in inspiratory muscle work and 
avoidance of respiratory muscle fatigue
Tidal volume is increased
CPAP counterbalances the inspiratory threshold 
work  related to intrinsic PEEP.
NIV improves respiratory system compliance by
  reversing microatelectasis of the lung
Enhanced cardiovascular function –
Afterload reduction d/t increased intrathoracic
pressure
Pathophysiology of acute hy
poxemic  respiratory failure
Pathophysiology of acute
hypercapnia
The modalities of NIV

most commonly used in emergency

departments are
CPAP (Continuous Positive Airway Pressure),
BiPAP (Bilevel Positive Airway Pressure) and
PSV (Pressure Support Ventilation)
MODE NIV

Cordova F et al. Non Invasive Mechanical Ventilation, 2010

Cordova F et al. Non Invasive Mechanical Ventilation, 2011
The term NPPV refers to bilevel positive airway
pressure (BPAP).
The ventilator cycles between an expiratory
positive-airway pressure (EPAP) and an
inspiratory positive-airway pressure (IPAP), with
the difference providing support that augments
tidal volumes and thereby increases ventilation.
Another frequently used means of providing
positive airway pressure is continuous positive-
airway pressure (CPAP).
Son DW et al. J Korean Soc Neonatol 2012;19:165-183
Cordova F et al. Non Invasive Mechanical Ventilation, 2011
Baptista FA et al. Emergencias 2009;21:189-202
SELEKSI PASIEN YANG MERUPAKAN
KANDIDAT UNTUK NIV
Stewart C. Emergency Medicine Practice 2001;3:7
Stewart C. Emergency Medicine Practice 2001;3:7
Baptista FA et al. Emergencias 2009;21:189-202
APLIKASI DARI NIV

Curtis JR et al. Crit Care Med 2007;35(3):932-939

Yeow ME et al. Emerg Med Clin N Am 2008;26:835-847
NIV ‐Advantages

Non invasiveness –
Flexibility in initiating and removing mechanical
  ventilation
–Allows intermittent application
–Improves patient comfort
–Reduces the need for sedation 
–Oral patency
•Preserves speech, swallowing and expectorati
on,  reduces the need for nagastrictubes
Avoid the resistive work imposed by the 
endotracheal tube
Avoids the complications of endotracheal 
intubation
Early (local trauma, aspiration)
Late (injury to hypopharynx, larynx, and tr
achea,  nosocomial infections)
Reduces infectious complications‐
pneumonia, sinusitis, sepsis
Less cost
N Engl J Med 2015;372:e30
Cardiogenic Pulmonary
edema

Ware LB et al. N Eng J Med 2005;353:2788-96

 .

Ornico et al. Critical Care 2013, 17:R39

 PROTOKOL PENGGUNAAN
NIV

• Pendekatan tinggi-rendah: dimulai dengan IPAP

tinggi (20-25 mmH2O), diturunkan jika pasien tidak
toleran
• Pendekatan rendah-tinggi: dimulai dengan IPAP
rendah (8-10 mmH2O), dinaikkan bertahap sampai
gejala sesak berkurang, RR turun, volume tidal
meningkat, dan sinkron antara pasien-ventilator
• EPAP biasanya diatur 3-4 mmH2O
• FiO2 dititrasi untuk menjaga pulse Oksimetri >90%
• delta IPAP-EPAP dapat diatur untuk meningkatkan
ventilasi menit lebih tinggi dan mengurangi
hiperkapnia
Baptista FA et al. Emergencias 2009;21:189-202
Yeow ME et al. Emerg Med Clin N Am 2008;26:835-847
Pemantauan penting untuk menilai
respon terapi
• Klinis: dispnea, fungsi otot-otot
pernafasan, kesadaran,
kenyamanan, distensi lambung.
• Variabel objektif:
- Pulse oxymetry
- CO2 ekspirasi (Capnometry)
- Analisa gas darah
Brochard L et al. Critical Care 2012;16:219
RINGKASAN

NIV menstabilkan pasien acute maupun

kronik respiratory failure.
Menghindarkan kebutuhan, bahaya
intubasi, dan lebih nyaman bagi pasien.
Bermanfaat dalam pengelolaan pasien
ARF, eksaserbasi penyakit obstruksi, dan
edema paru, dan penyapihan ventilator.
TERIMA KASIH
“Life is not measured by the breaths we take, but by the moments that take our
breath away”
-Hilary Cooper-
MEKANISME NIV