List the contraindications for and complications of non invasive ventilation.

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College Answer

Contraindications:
a)  Respiratory arrest
b)  Unprotected airway (coma, sedation)
c)  Inability to clear secretions
d)  Marked hemodynamic instability
e)  Oesophageal surgery or maxillofacial surgery pathology (eg ruptured
oesophagus)

Complications:

a)  Mask discomfort,  patient intolerance
·  b)  Facial or ocular abrasions, pressure necrosis

c)  Aspiration pneumonitis.
d)  Aerophagy and gastric distension
e)  Oronasal dryness
t)  Raised intracranial pressure
g)  Hypotension if hypovolemic

Discussion

Complications of non-invasive ventilation:

  • Mask intolerance, agitation and claustrophobia
  • Increased need for sedation
  • Delay of intubation
  • Aspiration
  • Poor clearance of secretions
  • Hypotension of hypovolemic patients
  • Facial pressure areas
  • Raised intracranial pressure
  • Aerophagy
  • Damage to facial, nasal and oesophageal surgical sites or traumatic injuries, leading to surgical emphysema, pneumothorax and pneumomediastinum

Contraindications of non-invasive ventilation

  • Decreased level of consciousness
  • Respiratory arrest
  • Vomiting
  • Hemodynamic instability
  • Poor clearance of secretions, eg. absent cough and gag
  • large sputum load and/or pneumonia
  • surgical or traumatic damage to the airways or oesophagus

References

References

Gay, Peter C. "Complications of noninvasive ventilation in acute care."Respiratory care 54.2 (2009): 246-258.