Introduction
This leaflet aims to explain what non-invasive respiratory support (NIRS) is and why you may need it as part of your treatment.
NIRS can refer to non-invasive ventilation (NIV), Continuous Positive Airways Pressure (CPAP) and High Flow Nasal Oxygen (HFNO)
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.
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.
During flare-up episodes OR at times when your breathing becomes difficult, NIRS can support your breathing muscles and gives you time to recover.
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.
Too much carbon dioxide can cause headaches, drowsiness and in some cases loss of consciousness. During these episodes NIRS can support your breathing muscles and gives you time to recover.
The best results are achieved if it’s used for most of the first 24hours.
However, it can be removed intermittently for ‘comfort’ breaks to allow you to, for example, eat and drink.
Treatment can be from 1-8 days depending on your response
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.
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 |
• Nasal bridge soreness • Claustrophobia • Skin rash • Ear/sinus pain • Aspiration • Mucus plugging • 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.
Patient: ‘You get instant relief…a few deep breaths and you are relaxed. It’s wonderful’
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 considered inappropriate.
If you choose not to try NIRS or remove it before your blood gases improve, a referral to the Palliative Care Team can be considered. They can advise on symptom management and helping with your comfor
Types of masks.
Although there are different types of masks these are the most common:-
NIV Full face mask
Nasal High Flow (HFNC)
CPAP (nasal mask)
For images of the above masks please download the full pdf version at the top of the page.
