TableĀ 3

Technical issues: a guide for when NIV is failing

ProblemCause(s)Solution (s)
Ventilator cycling independently of patient effortInspiratory trigger sensitivity is too high
Excessive mask leak
Adjust trigger
Reduce mask leak
Ventilator not triggering despite visible patient effortExcessive mask leak
Inspiratory trigger sensitivity too low
Reduce mask leak
Adjust trigger
For NM patients consider switch to PCV
Inadequate chest expansion despite apparent triggeringInadequate Tidal volumeIncrease IPAP. In NM or chest wall disease consider longer Ti
Chest/abdominal paradoxUpper airway obstructionAvoid neck flexion
Increase EPAP
Premature expiratory effort by patientExcessive Ti or IPAPAdjust as necessary
  • EPAP, expiratory positive airway pressure; IPAP, inspiratory positive airway pressure; NIV, non-invasive ventilation; NM, neuromuscular; PCV, pressure-controlled ventilation.