Advancing COPD + NIV

• What is the main focus of Lecture C in the BSc Physiotherapy course?

  Advancing COPD management and Non-Invasive Ventilation (NIV)
• What will students be able to do by the end of the lecture?

  Clinically reason when NIV is indicated and explain its principles for COPD management
• What is Non-invasive ventilation (NIV)?

  A method of ventilation using non-invasive interfaces to apply bilevel pressures to a patient’s respiratory system
• What does bilevel pressure in NIV refer to?

  Two pressures: inspiration and expiration pressures
• What is the purpose of ventilation?

  Oxygenation of the lungs and gas exchange to get rid of CO2
• In what situations is NIV considered an effective treatment?

  For ventilatory failure when air is not going in and out of the lungs
• What are some conditions NIV is used for?

  Acute exacerbation of COPD, cardiogenic pulmonary oedema, weaning from invasive ventilation, postoperative patients, neurological diseases, and obstructive sleep apnea
• How does NIV help in acute exacerbation of COPD?

  By improving respiratory mechanics and decreasing work of breathing
• What is acute ventilatory failure?

  When there is no gas exchange, leading to hypercapnia and hypoxaemia
• What happens to respiratory mechanics in COPD?

  Obstruction of airway, loss of lung elasticity, dynamic hyperinflation, and increased lung compliance
• What is the effect of COPD on work of breathing?

  The work of breathing is significantly increased, up to 3-4 times normal at rest
• What contributes to increased energy expenditure in COPD patients?

  More energy is required for breathing due to increased work of breathing
• What is ventilation-perfusion mismatch?

  Uneven distribution of air and blood flow in the lungs that impairs gas exchange
• What are the consequences of hypoxaemia in COPD?

  Reduced oxygen levels in the blood due to V/Q mismatch and diffusion impairment
• What is the role of Continuous Positive Airway Pressure (CPAP)?

  It provides no difference between inspiration and expiration pressures
• What is the purpose of Expiratory Positive Airway Pressure (EPAP)?

  To improve oxygenation by increasing functional residual capacity and relieving upper airway obstruction
• What are the physiologic effects of Inspiratory Positive Airway Pressure (IPAP)?

  It improves tidal volume and minute ventilation
• What are the common problems associated with NIV interfaces?

  Difficulty to eat and speak, aspiration due to secretions, and discomfort
• What are the absolute contraindications for NIV?

  Respiratory arrest and inability to fit the mask
• What is the benefit of non-invasive ventilation for obstructive airway disease?

  Positive pressure stents open airways
• How does NIV help with diaphragmatic dysfunction?

  High-intensity pressure support ventilation with backup rate reduces diaphragm effort and controls the mechanism of breathing
• What overall effects does NIV have on respiratory mechanics, work of breathing, and gas exchange?

  Increased elasticity, decreased work of breathing, and improved oxygenation
• What is the significance of early use of NIV in COPD patients with mild respiratory acidosis?

  It prevents further deterioration and avoids endotracheal intubation, improving survival
• What guidelines support the use of NIV in acute respiratory failure?

  BTS/ICS Guideline, ERS/ATS Clinical Practice Guidelines, and NICE Guideline NG115
• What are the indications for NIV in acute care?

  Increased dyspnoea, tachypnoea, signs of increased work of breathing, and acute ventilatory failure
• What are the relative contraindications for NIV in acute care?

  Medically unstable conditions, agitation, inability to protect airway, and excessive secretions
• What is the overall purpose of NIV in treating acute respiratory failure?

  To improve survival and reduce complications compared to medical therapy
• What is the significance of COPD as a condition in Central Manchester?

  It is a significant and debilitating condition prevalent in the area
• How can NIV be used long-term in COPD patients?

  NIV can help recover from acute situations and be used as the disease progresses to severe stages and palliation
• What are the key benefits of Non-invasive Ventilation (NIV) for COPD patients?

  • Improves respiratory mechanics
  • Decreases work of breathing
  • Enhances gas exchange
  • Provides comfort to patients
• What are the pathophysiologic targets of NIV in patients with severe COPD?

  • Obstructive airway disease: Positive pressure opens airways
  • Alveolar destruction: EPAP reduces respiratory muscle load
  • Diaphragmatic dysfunction: High-intensity pressure support reduces diaphragm effort
• What are the common indications and contraindications for NIV?

  Indications:

  • Acute respiratory failure
  • Acute hypercapnic exacerbations of COPD
  • Increased dyspnoea

  
  

  Contraindications:

  • Apnea
  • Facial trauma
  • Inability to handle secretions
• What are the physiological effects of Inspiratory Positive Airway Pressure (IPAP) and Expiratory Positive Airway Pressure (EPAP)?

  IPAP:

  • Improves tidal volume and minute ventilation

  
  

  EPAP:

  • Improves oxygenation and relieves upper airway obstruction
• What are the signs indicating the need for NIV in acute care?

  • Increased dyspnoea
  • Tachypnoea (>24 breaths/min in obstructive)
  • Signs of increased work of breathing
• What are the potential complications of using NIV interfaces?

  • Difficulty eating and speaking
  • Aspiration due to secretions
  • Pressure ulcers on the face
• What is the overall effect of NIV on patients with acute respiratory acidosis caused by COPD exacerbation?

  • Benefits most from NIV
  • Prevents further deterioration
  • Improves survival compared to standard medical therapy