ABSTRACT
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
GENERAL APPROACH TO NON-INVASIVE VENTILATION PROBLEMS
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.
