As we developed our system of care in the VA system, we attempted to identify barriers to NIPPV utilization in our patients.
The concept of early NIPPV is not novel and there is evidence to support implementation.
The current practice parameters recommend initiating NIPPV when the patient's FVC reaches 50 percent predicted or the patient complains of shortness of breath .
A recent systematic review of NIPPV
in severe stable COPD patients was conducted by Kolodziej and coworkers .
NIPPV also is covered by insurance if nocturnal oximetry is lower than 88% for 5 or more continuous minutes (Cigna Healthcare Medicare Administration, 2004).
While the FVC is the tool that often is used to qualify ALS patients for NIPPV, FVC alone may not adequately measure early respiratory insufficiency in the ALS population.
The use of NIPPV
in the controlled mode results in laryngeal aperture narrowing and may decrease the delivered tidal volume during NIPPV
New chapters explore key topics such as ventilatory management for obstructive pulmonary disease, adult respiratory distress syndrome, NIPPV
, tracheal gas insufflation, prone positioning, and liquid ventilation.
Hans Rudolph introduces the "Alizes", a Newly designed Nasal CPAP/Bi-Level/ NIPPV
Mask & Swivel Port assembly that can withstand steam Autoclaving, Dishwashers & Cold Chemical disinfection.