- Reference Number: HEY1545/2024
- Departments: Respiratory Medicine
- Last Updated: 31 October 2024
Introduction
This leaflet has been produced to give you general information about non-invasive ventilation (NIV). Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and your doctor but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.
What is NIV?
NIV is a way of supporting your breathing. If your breathing becomes difficult and your chest muscles tire it can lead to a condition called type 2 respiratory failure which is a build-up of carbon dioxide and not enough oxygen getting into your blood. The NIV machine does not breathe for you but helps blow extra air into your lungs with every breath you take. This allows you to rest your breathing muscles with the aim of increasing your oxygen levels and reducing the carbon dioxide levels in your blood.
How does NIV work?
People receiving NIV need to wear a cushioned mask that is connected to a machine. People are usually offered a mask that fits over the nose and mouth initially, but there is also an option for a mask that fits over the full face. The mask is tight-fitting and is secured with straps that go around your head.
When the machine is turned on, you will feel the air blowing when you breathe in and out. This helps keep your airways open. It can feel strange at first, but a nurse will stay with you until you feel more comfortable and just breathe as normal. You can talk with the mask on, but it might be difficult to talk against the air. The mask will be taken off regularly and at your request to give you breaks and so you can eat and drink. If you need to cough up any phlegm, let the staff know and they will take the mask off for you.
Why do I need NIV?
NIV is a common treatment and is used in different illnesses. Sometimes these conditions can lead to type 2 respiratory failure. Usually, a member of staff will take a blood sample (usually from an artery in your wrist) and if the result shows you have low oxygen levels, high carbon dioxide levels and your blood is acidic, NIV may be considered. Your body creates carbon dioxide when your cells make energy. Your red blood cells carry it from your organs and tissues to your lungs, where you breathe it out. If your body can’t get rid of carbon dioxide, a waste product, it can build up in your blood and cause your blood to become acidic.
How long will I need NIV for?
Everyone is different and the length of time you need to wear the mask depends on how quickly your carbon dioxide and oxygen levels improve. For the first 24 hours, you will usually be asked to wear the mask as much as possible (with breaks for meals) including overnight when you sleep. Another blood test may be done the next day. Some people then have longer breaks off NIV the next day, whereas others need to wear the mask all the time for the next 24 hours. In some cases, people stop NIV then their carbon dioxide levels rise again so they need the treatment for a little bit longer. Everyone is different!
Will I need NIV again?
If you have received NIV, there is a possibility you may need it again in the future. Many people find it helpful discussing their thoughts on having NIV in the future with a doctor so their wishes can be documented.
Can there be any complications or risks?
NIV is a life-saving treatment that is commonly used in hospitals. However, like any treatment, there is the possibility of side effects. These include skin breakdown where the mask sits, bloating if air goes into your stomach, dry mouth and eyes and a drop in blood pressure. However, these side effects can be helped by regular breaks from NIV, padding around the mask/alternative masks, a thin tube through your nose into your stomach to remove the air, regular mouth care and changing the machine settings. Please let your doctor, nurse or physiotherapist know if you experience any of these side effects.
How will I feel if my carbon dioxide builds up?
This is different for every patient, but symptoms include breathlessness (worse than normal), chest tightness, drowsiness, headaches (especially in a morning), muddle-headedness (“fuzzy” thinking, difficulty concentrating and confusion), involuntary twitching and more wheeze than normal. Some people also have vivid dreams and/or disturbed sleep.
What is a RESPECT form and do I need one?
ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment. The ReSPECT process creates a personalised recommendation for your clinical care in emergency situations where you are not able to make decisions or express your wishes. This plan can be for anyone and is created through conversations between you and your health professionals. This is to ensure there is an agreed and documented plan with your needs, wants and wishes, as well as your health professional’s medical advice which will help identify your priorities of care. The plan should stay with you and should be available immediately to health professionals called to help you in an emergency, whether you are at home or being cared for elsewhere. In an emergency where you are not able to say what is important to you, clinical decisions will be made by health professionals trying to act in your best interests. This is why we encourage everyone to think about what they would want to happen in an emergency so they can be involved in decision making. While in hospital you may have had this discussion already taken place, but if you’re unsure or can’t remember, please ask whoever is caring for you for more information. A conversation may have been had with your family if you were unable to have the conversation at the time of being unwell.
What happens afterwards?
If you are admitted to hospital and receive non-invasive ventilation for type 2 respiratory failure (as we have discussed above) and you have a condition called COPD – Chronic Obstructive Pulmonary Disease, our Respiratory Nurse Specialist team will aim to review your care and will visit you in hospital. They will speak to you about what brought you into hospital, ask about your past medical history, social history, review your medications and discuss the signs and symptoms of type 2 respiratory failure. They may also have a discussion with you about your ReSPECT form if there is already one in place, and if not, may have some discussion with about what priorities you would want in your care should you need NIV again. Once you are well enough to be discharged home, the Respiratory Nurse Specialist team will arrange to see you in your home environment in approximately 6 weeks’ time from the date of discharge. This is to ensure you have recovered from your recent illness and will involve taking a small pin prick blood sample from your ear called a capillary blood gas (CBG). This blood test will look at the acidity, carbon dioxide and oxygen level of the blood to ensure the type 2 respiratory failure has resolved.
Who do I contact if I feel unwell?
If you notice any of the signs and symptoms as previously discussed such as headaches, twitching, increased confusion, drowsiness, you must call 111. Or in an emergency and in severe cases, loss of consciousness dial 999 immediately.
Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Respiratory Clinical Assessment Service on tel: 01482 675035. Working hours are between 08.00am to 16.30pm 7 days a week.
