Technical issues: a guide for when NIV is failing
| Problem | Cause(s) | Solution (s) |
|---|---|---|
| Ventilator cycling independently of patient effort | Inspiratory trigger sensitivity is too high Excessive mask leak | Adjust trigger Reduce mask leak |
| Ventilator not triggering despite visible patient effort | Excessive mask leak Inspiratory trigger sensitivity too low | Reduce mask leak Adjust trigger For NM patients consider switch to PCV |
| Inadequate chest expansion despite apparent triggering | Inadequate Tidal volume | Increase IPAP. In NM or chest wall disease consider longer Ti |
| Chest/abdominal paradox | Upper airway obstruction | Avoid neck flexion Increase EPAP |
| Premature expiratory effort by patient | Excessive Ti or IPAP | Adjust as necessary |
EPAP, expiratory positive airway pressure; IPAP, inspiratory positive airway pressure; NIV, non-invasive ventilation; NM, neuromuscular; PCV, pressure-controlled ventilation.