Hospital Ventilation Success - Systems & Techniques

Hospital ventilation: devoted to success

    It can be a challenge to keep up with the latest innovations in hospital ventilation systems and techniques, and the many ways they are changing the management of patients with respiratory failure. Staying up to date on emerging applications, including noninvasive ventilation (NIV) and high-flow therapy, is important given how many patients are ventilated during a hospital stay and the importance of weaning to reduce complications from continued breathing assistance.

    50 percent stat
    50%+ of ICU patients are intubated within 24 hours of admission1
    310 stat
    310 per 100,000 U.S. adults undergo invasive ventilation for nonsurgical indications2
    40 percent stat
    40% of the total duration of mechanical ventilation is the weaning process3

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    NIV and high-flow nasal cannula: emerging applications

     

    It’s no exaggeration to say that NIV has revolutionized the treatment of acute respiratory failure.4 And recently, high-flow nasal cannula (HFNC) oxygen delivery has gained popularity as part of a strategy for supportive therapy in many clinical situations, including weaning.

     

    Learn what experts are saying about these modalities.

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    Clinical summary
    Read an evidence-based clinical summary of the literature
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    NIV vs HFT Quiz

    Which therapy would you use for a chronic obstructive pulmonary disease patient with exacerbation? Or when treating a hypoxemic or cardiogenic pulmonary edema patient? Test your knowledge about which treatment is recommended for these conditions and others.
    intro quiz

    NIV vs HFT Quiz

    Play video and select an answer

    Which therapy would you use for a COPD patient with exacerbration?

    COPD patient with exacerbration question video
    Reproduciraj
    NIV
    HFT
    Both

    NIV vs HFT Quiz

    Answer

    COPD patient with exacerbration answer video
    Reproduciraj
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    NIV vs HFT Quiz

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    Which therapy would you use for a COPD patient with community-acquired pneumonia?

    Pneumonia question video
    Reproduciraj
    NIV
    HFT
    Both

    NIV vs HFT Quiz

    Answer

    Pneumonia answer video
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    NIV vs HFT Quiz

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    Which therapy would you use for a Immunocompromised patient?

    Immunocompromised question video
    Reproduciraj
    NIV
    HFT
    Both

    NIV vs HFT Quiz

    Answer

    Immunocompromised answer video
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    NIV vs HFT Quiz

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    Which therapy would you use when treating a hypoxemic?

    Hypoxemia question video
    Reproduciraj
    NIV
    HFT
    Both

    NIV vs HFT Quiz

    Answer

    Hypoxemia answer video
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    NIV vs HFT Quiz

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    Which therapy would you use when managing a cardiogenic pulmonary edema patient?

    Cardiogenic Pulmonary Edema question video
    Reproduciraj
    NIV
    HFT
    Both

    NIV vs HFT Quiz

    Answer

    Cardiogenic Pulmonary Edema answer video
    Reproduciraj
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    NIV vs HFT Quiz

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    Which therapy would you use when treating a post-extubation patient?

    Post-extubation question video
    Reproduciraj
    NIV
    HFT
    Both

    NIV vs HFT Quiz

    Answer

    Post-extubation answer video
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    NIV vs HFT Quiz

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    Which therapy would you use when managing a postoperative abdominal patient?

    Postoperative question video
    Reproduciraj
    NIV
    HFT
    Both

    NIV vs HFT Quiz

    Answer

    Postoperative answer video
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    Complete

    NIV vs HFT Quiz

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    Restart quiz
    **No matching rule found. Please select another answer

    Why NIV over invasive ventilation?

     

    Clinicians understand that while invasive ventilation can be lifesaving, the risk of potential complications – like infections and injury to the lungs and other organs – runs high. That’s why NIV has become a widely used therapy option and is now considered the mode of choice for some conditions.

     

    NIV has also been associated with reduced length of hospital stay and reduces mortality, patient discomfort and length of-stay for exacerbations of COPD compared to standard therapy.5

    Advantages of NIV over invasive ventilation

    Application

    • Avoid intubation
    • Patient discomfort
    • Upper airway trauma

     

    Minimize ventilator acquired pneumonia6

    • Intubation is associated with GI bleeding
    • Less chance of barotrauma

     

    Decreases work of breathing

    • Improves alveolar ventilation
    • Improves gas exchange
    • Counterbalances intrinsic PEEP

    Oral patency

    • Preserves efficiency of cough and secretion clearance
    • Allow speech, allowing the patient to communicate
    • Preserves ability to swallow
    • Reduces need for NG tube

    Transitioning to NIV?

    Here are some tips:

     

    Set realistic expectations – NIV does not avoid intubation in all cases – a NIV failure rate of 20-40% is expected based on current clinical evidence.7

     

    Experience matters – Only practice of NIV will lead to the needed experience to perform successful NIV.

    Noninvasive ventilation is one of those rare medical technologies that both improves patient outcomes and reduces treatment costs.”

    – Adam Seiver, MD, PhD, MBA, chief medical officer, Philips Monitoring and Analytics & Therapeutic Care

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    Avoid NIV complications


    Complications with NIV can be pressure-related
    Complication
    Remedy8
    Nasal congestion
    Try humidification or speak to the physician for various remedies to assist with this problem
    Nasal or oral dryness
    Add humidification, nasal saline, oral/nasal hygiene, or decrease leak
    Sinus or ear pain
    Lower inspiratory pressure
    Gastric inflation
    Avoid excessive inspiratory pressures (over 20 cmH2O)
    Eye irritation
    Check mask fit, readjust bottom headgear straps, and be aware of air leaks near eyes
    Failure to ventilate
    Use sufficient pressures, optimize patient-ventilator synchrony
    Complication
    Nasal congestion
    Remedy8
    Try humidification or speak to the physician for various remedies to assist with this problem
    Nasal or oral dryness
    Try humidification or speak to the physician for various remedies to assist with this problem
    Sinus or ear pain
    Lower inspiratory pressure
    Gastric inflation
    Avoid excessive inspiratory pressures (over 20 cmH2O)
    Eye irritation
    Check mask fit, readjust bottom headgear straps, and be aware of air leaks near eyes
    Failure to ventilate
    Use sufficient pressures, optimize patient-ventilator synchrony
    Complication
    Nasal congestion
    Remedy8
    Try humidification or speak to the physician for various remedies to assist with this problem
    Complication
    Nasal or oral dryness
    Remedy8
    Try humidification or speak to the physician for various remedies to assist with this problem
    Complication
    Sinus or ear pain
    Remedy8
    Lower inspiratory pressure
    Complication
    Gastric inflation
    Remedy8
    Avoid excessive inspiratory pressures (over 20 cmH2O)
    Complication
    Eye irritation
    Remedy8
    Check mask fit, readjust bottom headgear straps, and be aware of air leaks near eyes
    Complication
    Failure to ventilate
    Remedy8
    Use sufficient pressures, optimize patient-ventilator synchrony
    Complications can also be mask-related
    Complication
    Remedy8
    Discomfort
    Check fit, adjust straps, or change the mask
    Nasal or oral dryness
    Add humidification, nasal saline, oral/nasal hygiene and manage leak by decreasing the amount of leak
    Nasal bridge redness or ulceration
    Use an artificial skin, minimize strap tension, use LiquiCell, alternate masks or use a PerforMax or Total face mask
    Skin irritation or rashes
    Use a skin barrier lotion and/or topical corticosteroids, change to a mask made from a different material, be sure to properly clean the mask
    Claustrophobic reactions
    Try a nasal mask or PerforMax or Total face mask; sedate judiciously
    Complications can also be mask-related
    Complication
    Remedy8
    Discomfort
    Check fit, adjust straps, or change the mask
    Nasal or oral dryness
    Add humidification, nasal saline, oral/nasal hygiene and manage leak by decreasing the amount of leak
    Nasal bridge redness or ulceration
    Use an artificial skin, minimize strap tension, use LiquiCell, alternate masks or use a PerforMax or Total face mask
    Skin irritation or rashes
    Use a skin barrier lotion and/or topical corticosteroids, change to a mask made from a different material, be sure to properly clean the mask
    Claustrophobic reactions
    Check mask fit, readjust bottom headgear straps, and be aware of air leaks near eyes
    Complications can also be mask-related
    Complication
    Discomfort
    Remedy8
    Check fit, adjust straps, or change the mask
    Complication
    Nasal or oral dryness
    Remedy8
    Add humidification, nasal saline, oral/nasal hygiene and manage leak by decreasing the amount of leak
    Complication
    Nasal bridge redness or ulceration
    Remedy8
    Use an artificial skin, minimize strap tension, use LiquiCell, alternate masks or use a PerforMax or Total face mask
    Complication
    Skin irritation or rashes
    Remedy8
    Use a skin barrier lotion and/or topical corticosteroids, change to a mask made from a different material, be sure to properly clean the mask
    Complication
    Claustrophobic reactions
    Remedy8
    Check mask fit, readjust bottom headgear straps, and be aware of air leaks near eyes
    Did you know?
    37.5 percent stat
    37.5% of patients fail NIV because of mask intolerance and discomfort, a reason recognized as one of the most common for NIV failure. This is because the mask was not fitted properly or it’s the wrong type of mask for the patient.9

    Hospital respiratory ventilators – the right care at the right time

     

    Philips hospital ventilators are designed to help you respond quickly to changing patient conditions, across the continuum, while delivering consistent quality care.

    Hospital ventilation masks – flexibility and ease, for you and your patients

     

    Length of therapy, the type of delivery device, safety features and the patient’s facial features are all factors to consider when selecting a mask. Philips respiratory masks and interfaces offer a range of options to help you make quick therapy transitions.

    Education and resources

     

    Explore webinars, courses and videos for practice guidelines and ways to enhance your hospital ventilation program’s success.

    Evidence in support of NIV and HFNC

     

    Register to view this webinar about current evidence and practice – and receive CEs.

    Skin integrity training

     

    LeBonheur Children’s Hospital and Philips team up to bolster staff education through Philips Saving Face NIV mask rotation training program.

    HFNC and NIV current and practice

     

    This presentation reviews evidence in support of NIV and discusses the research evaluating HFNC and its role in the management of respiratory failure.

    Strategies to help avoid asynchrony

     

    Patient-ventilator asynchrony is common during NIV and interferes with effective delivery as well as safety. Determine which key strategies can help avoid asynchrony.

    References

    1. According to the American Association for the Surgery of Trauma (AAST).

    2. Mehta AB, Syeda SN, Wiener RS, Walkey AJ. Epidemiological trends in invasive mechanical ventilation in the United States: a population-based study. J Crit Care. 2015;30(6): 1217-1221.

    3. McConville JF, Kress JP. Weaning patients from the ventilator. N Engl J Med. 2012;367(23):2233-2239.

    4. Scott K. Epstein, MD, Respiratory Care, January 2009 Vol 54 No 1.

    5. Keenan SP, Gregor J, Sibbald WJ, Cook D, Gafni A. Noninvasive positive pressure ventilation in the setting of severe, acute exacerbations of chronic obstructive pulmonary disease: more effective and less expensive. Crit Care Med. 2000 Jun;28(6): 2094-102.

    6. Respiratory Care, Feb 2009 54(2):198-211)

    7. Hess D. How to Initiate a Noninvasive Ventilation Program: Bringing the Evidence to the Bedside. Respiratory Care (2009), Vol 54 NO 2: p. 232-245.

    8. Nava, S., et al. Interfaces and Humidification for Noninvasive Mechanical Ventilation. Resp. Care. Jan 2009. Vol 54-1.

    9. Squadrone E, et al. Noninvasive vs invasive ventilation in COPD patients with severe acute respiratory failure deemed to require ventilatory assistance. Inten Care Med. 2004;30(7).

     

    Philips is not a medical care provider, and this information is not intended to diagnose, examine treat or manage medical conditions of any kind. The content on this page is not a substitute for professional judgment by a healthcare provider.