Introduction
This leaflet aims to explain what non-invasive respiratory support (NIRS) is and why you may need it as part of your treatment depending on outcomes required.
NIRS can refer to non-invasive ventilation (NIV) also known as BiPAP (bilevel positive airway pressure), Continuous Positive Airways Pressure (CPAP) and High Flow Nasal Oxygen (HFNO).
What is NIRS?
NIV, CPAP and HFNO are machines that support your breathing by blowing extra air into your lungs. These machines provide respiratory support when you take a breath, but do not breathe for you.
It typically involves wearing a facemask covering the nose and mouth or in some circumstances using a nasal mask or cannulae. The mask will be connected to the NIV, CPAP or HFNO machine which will assist you to take deeper breaths, increasing the oxygen levels in your blood and/or reducing your carbon dioxide level.
Why do I need NIRS?
Without sufficient oxygen, your body’s organs struggle to work as well as they should but equally too much oxygen can cause harm in some situations, this will be monitored, and you may need to have arterial blood gases taken or capillary blood gases (either bloods taken from the wrist or the earlobe). Too much carbon dioxide can cause headaches, drowsiness and in some cases loss of consciousness. During flare-up episodes OR at times when your breathing becomes difficult, NIRS can support your breathing muscles and gives you time to recover.
Risk factors associated with use of NIV, CPAP, HFNO
NIRS masks can be uncomfortable for some however, for the treatment to be effective, the masks need to fit snuggly/securely and this is one of the problems associated with wearing it.
Other problems with the mask include:
| Common | Uncommon |
|---|---|
| • Mask discomfort • Nasal or oral dryness • Blowing air into stomach • Eye irritation • Nasal or oral congestion • Claustrophobia |
• Nasal bridge soreness • Skin rash • Ear/sinus pain • Aspiration (either food, drink or sputum going down the wrong way) • Thick mucous blocking the airway • Low blood pressure |
The nurses will be monitoring you closely to identify and minimise any problems. You will have your patient call bell at hand so you can inform the nursing staff of any concerns.
Positive outcomes
• Reduce carbon dioxide levels
• Improve alertness/reduce tiredness
• Reduce effort of breathing
• Reduce headaches
Types of masks
Although there are different types of masks these are the most common
NIV Full Face Mask
Nasal High Flow (HFNO)
CPAP (Nasal mask)
What if I choose not to use NIRS?
A breathing tube and ventilation (invasive ventilation) in intensive care unit (ICU) is an option generally considered by the medical team before NIRS. However, this has associated risks including delirium, cognitive impairment, ICU acquired weakness and infections. Therefore, for some patients it is not appropriate and the medical team will, where possible, discuss this with you and your family.
It is always your choice to decline or stop treatment at any time. If you do, we will fully support your decision and focus entirely on your comfort. We can involve the Palliative Care Team, who are able to support in symptom management and help keep you comfortable.
How long will I need to use it?
NIV masks can be removed for short breaks to allow you to eat and drink. If you are using High Flow Nasal Oxygen (HFNO), you may be able to eat and drink while wearing the device.
The length of time you require the treatment will depend on your response to it.
Will I need it again?
If you have COPD, it may be an indication that your disease is progressing and you may require NIV again in the future or in some circumstances, this may be considered long term or further investigations may be appropriate. You will be offered an appointment in the NIV follow up clinic on discharge to review this.
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Author Respiratory Department
Approved by Respiratory Governance and Business Meeting
Date of Publication 29/05/2029
Reference No PL/1413 (v2)
Review Date 01/05/2029
