Non – Invasive Ventilators (NIV) are the simple or the ventilator support offered to the patients without the involvement of an Intubation (invasive artificial airway) like an endotracheal tube or tracheostomy tube. The main equipment used in this type of ventilator is a face mask, nasal mask, or a helmet mask.

These 3 types of masks can be used to administer the ventilator. These ventilators can be used both within or outside the intensive care unit (ICU). However, like other equipment that has both advantages and disadvantages, so is with Non-Invasive Ventilator. Here, you will get to know some of the advantages and limitations of these non-invasive ventilators.

Advantages of Non-Invasive Ventilators

Listed below are the advantages of non-invasive ventilators:

Suitable for Domestic use

The Non-Invasive ventilators do not require any special skills or professional expert to operate it. Although it is never advised that an unskilled person handles these masks and circuits, its usage does not require any medical expert. Ventilation of OSA patients can be done at home easily with these ventilators.

Budget-friendly

These ventilators do not require a team of medical professionals. Only a single nurse can handle it very well as it does not require any endotracheal tube or tracheostomy tube. Also, Shifting the patient to ICU is not necessary for this ventilator support. It can be used inwards also. Hence, it cut down the cost of extra medical staff and ICU.

Manageable Oxygen Concentration and airway pressure

The best thing about this Non-Invasive Ventilator is its property of Managing the airway pressure and oxygen concentration. The tightly fitted mask seals the airway together with the ventilator circuit. This enables the ventilator to deliver the desired air pressure and oxygen concentration. The ventilator sounds the alarm in case of any disturbance in airway pressure or oxygen concentration.

Tolerable

Non- Invasive ventilators are tolerable for the patients as it does not touch the larynx and reduce the chances of infections. There is no requirement for sedation or muscle relaxants.

In Invasive Ventilators, it is crucial to finish the process in a single go while on the other hand, non-invasive ventilators can be discontinued and started again.

Limitations of Non-Invasive Ventilators

Though there are advantages of non-invasive ventilators, they also pose certain limitations such as:

Time-consuming set-up

Setting up of Non- Invasive ventilator can consume a minimum of 5 minutes which can be fatal in severe cases. It is hard to tell who will be benefitted from NIV and who require Invasive ventilators but, in some cases, NIV is a huge failure, like:

•  Shock

•  Acidosis

•  Extensive bilateral x-ray changes

•  Severe Hypoxia (1)

NIV is uncomfortable

Although NIV is tolerable it is comfortable at times. The common discomforts of using NIV are:

•  Masks fit so tightly and create pressure areas.

•  Makes noise

•  Leads to humidity

In some cases, mask failures lead to air leakage.

Patients experience nausea and vomiting

Many times patients end up swallowing the air that leads to coughing or other activities and can increase airway pressure. An increase in airway pressure leads to nausea and vomiting.

Should not be used if the patient is physically constrained

In case of any physical injury to the patient, NIV is not safe as the patient is unable to remove the mask in case of vomiting that can lead to asphyxiation.

Not recommended for the patients in coma

Patients in com cannot perform self-respiratory efforts. The forced gas into the unprotected upper air passage of such patients can lead to gastric insufflation and aspiration. That is why it is not safe for the use of comatose patients.

Conclusion:

While it is not easy to tell which patient needs NIV or which need an Invasive Ventilator, but it is necessary to check for certain signs before deciding if NIV will work on the patient or not. For uncooperative patients, patients with unprotected upper airway, unstable blood pressure, or in case of excessive secretion, NIV is a big ‘NO’.

In the case of COVID-19, NIV is not a good option for every patient depending on the severity of the symptoms. Although NIV can reduce the sufferings of many patients facing respiratory issues, Invasive Ventilators should also be kept as an alternative for severe cases. The patients under the NIV treatment need to get the blood air checked regularly.