critical care medicine
How To Do Noninvasive Positive Pressure Ventilation
Step by Step Description of Noninvasive Positive Pressure Ventilation
Determine the appropriate face mask size by fitting the fitting wheel over the bridge of the patient’s nose, and rotating the wheel to select the size that covers the entire mouth. Secure the forehead part of the head strap about the patient’s head. Do not fasten the strap too tightly; allow one or two finger widths under the strap and then tighten it. Fasten the lower straps to the mask on each side. Attach the top portion of the mask to the forehead strap. This top portion of the mask may have fine adjustments: in or out, up or down, to optimize patient comfort. Connect the BPAP tubing to the patient, with the carbon dioxide release valve pointing away from the patient. Typical initial BPAP pressure settings are: IPAP = 10 to 12 cm water and EPAP = 5 to 7 cm water. Adjust the position of the mask as needed to maintain a good seal against the face. A small air leak, such as 5 L/minute, is negligible. Sequentially observe the patient, beginning 30 minutes after initiating BPAP, to assess ventilation and patient comfort, and increase IPAP to 15 to 20 cm water as needed. 