chapter  9
10 Pages

Problem-solving in acute non-invasive ventilation S Heather, M Chatwin and A K Simonds

General approach to non-invasive ventilation problems 113

Persistent hypercapnia 114

Leaks 115

Persistent hypoxaemia 115

Asynchrony between patient and ventilator 116

Hypocapnia/respiratory alkalosis 117

Confusional state/aggressive behaviour 117

Unexpected high inflation pressures and/or difficulty inflating chest 118

Nasal problems 118

Gastric distension 119

Rapid eye movement (REM) sleep rebound 120

Troublesome cough 120

Pneumothorax 120

Claustrophobia 121

24 Hour non-invasive ventilation use 121

Ventilator overdependence 122

References 122


Non-invasive ventilation (NIV) is not a universal panacea in patients with respiratory insufficiency. There is an established failure rate of around 5-40 per cent depending on the application (see Chapters 2 and 4-7), which may be due to:

• Primary failures (ie. failure to initiate therapy), or • Late (secondary) failures in patients already established on NIV.