Home non-invasive mechanical ventilation (NIV)

What is non-invasive mechanical ventilation?

Non-invasive mechanical ventilation (NIMV) is a type of respiratory support that helps the patient breathe using a positive pressure ventilator, through an interface and without the need for an artificial airway such as a tracheostomy.

The interfaces are designed to fit comfortably against the face and allow for the efficient delivery of pressurized air. The most common ones include:

• Nasal or oronasal masks.
• Full face masks.
• Nasal pads (small tubes that fit into the nostrils).
• Mouthpieces or lip seals.

Today, the variety of standard masks available offers high adaptability and comfort, avoiding the need for custom-made devices in most cases.

Ventajas y consideraciones de la VMNI

NIV offers significant benefits compared to other invasive methods, although it may also have certain limitations.

Main advantages:

• Avoids the need for a tracheostomy, reducing the risk of infection.
• Allows the patient to speak, swallow, and maintain their sense of taste and smell during therapy.
• Improves quality of life and reduces dependence on continuous care.
• Compatible with partial (several hours) or prolonged (up to 24 hours) use, depending on medical need.

Possible drawbacks:

• Initial discomfort or claustrophobia when wearing the mask.
• Air leaks due to poor fit, which reduce the effectiveness of the treatment.
• Reduced effectiveness in patients with abundant secretions or severe bulbar involvement.
• Gradual adaptation is necessary to improve tolerance and comfort.

What types of masks or interfaces are commonly used for VMNI?

Choosing the right type of mask is crucial, both for fit and ventilation effectiveness. It's important that it:

• Is small enough to minimize dead space.
• Fits the patient's face shape to minimize air leakage
• Is comfortable to wear and tear, to prevent adverse effects such as skin irritation in pressure areas.
• Is easy to put on, for both the patient and caregivers.

Nasal mask

The nasal mask offers several advantages, including ease of use, reduced claustrophobia, the ability for the patient to expectorate without removing the mask, and fewer potential complications in case of vomiting. Furthermore, its small size creates minimal dead space.

However, a significant problem is leakage due to poor sealing of the interface, which must be prevented with a secure fit using a cap or harness, or leakage from the mouth, which can sometimes be resolved by using a chin strap or oronasal mask.

Oronasal or facial mask.

The oronasal or full-face mask, by covering the nose and mouth, prevents oral leakage in patients who breathe through their mouths. It also allows for higher pressure support with less leakage and requires less cooperation from the patient.

The disadvantages of the full-face mask are that it is more uncomfortable and bulky, which can cause claustrophobia, and it creates more dead space. Furthermore, it can sometimes cause leaks if the mask is not properly fitted to the patient's facial anatomy.

Mouth piece

The mouthpiece facilitates communication and clearance of secretions. However, adverse effects have been described, such as dry mouth, an increased risk of aspiration, altered dental occlusion, and temporomandibular joint problems. They are especially useful in situations of high ventilator dependence. However, they can hardly be tolerated for more than 16 hours per day.

Material for treatment

To carry out this treatment it is necessary:

a. The ventilator, which generates airflow at a specific pressure.

b. The tubing, the piece that connects the ventilator to the patient.

c. The air humidifier, which is optional, is placed at the ventilator's air outlet and helps prevent dryness of the mucous membranes.

d. An interface (nasal mask, prongs, mouthpiece, face mask, or full-face mask) that connects the patient to the ventilator. Different types and varieties of interfaces are available to achieve better adaptation to the ventilator.

How to use the ventilator

Place the ventilator on a bedside table, near the headboard, so that it cannot fall over during sleep. Make sure you do not place the machine somewhere where someone might bump into it or trip on its power cable.

Ensure the area around the machine is clean and dry. The machine should be positioned so that nothing is obstructing the air inlet found at the back of the ventilator. Connect one end of the power cable to the ventilator and plug the other into the mains.

A light will come on to indicate that the ventilator is plugged in.* Connect the tubing to the interface (and to the humidifier if this has been prescribed).

The treatment may be more comfortable for the patient if a humidifier is used to humidify the air they are breathing. The humidifier tank, which is attached to the ventilator, must be filled with distilled water up to the corresponding line.

Every time the ventilator is moved, first, the remaining water must be emptied, and then, the humidifier must be disconnected.

* This depends on the model of the machine. Check the instruction manual.

Masks

There are two types of masks:

How to use the mask

There is no need to alter the headgear on the mask provided by OXIGEN salud every time you use it. The care team will fit it to your head when they install the machine.

Maintenance and cleaning

The care team of OXIGEN salud will carry out regular checks on the equipment. However, it is important to follow the hygiene and cleaning guidelines described below, as they will make the treatment more comfortable and ensure the machine lasts as long as possible.