Non-invasive Positive Pressure Support, commonly known as NIPPV, is a process of delivery of mechanical ventilation to those patients who need support to breathe (at certain times). NIPPV doesn’t need an artificial airway through the larynx or trachea. NIPPVhas emerged as one of the most important advances in the management of both acute and chronic respiratory failure in the past two decades. Earlier, non-invasive ventilation could only be administered through devices that generated negative pressures like the cuirass or the iron lung (now obsolete).
To fully understand NIPPV, one must understand its different types or ‘modes’. NIPPV can use a pressure or volume-controlled mode (both of which generate positive pressure) to deliver ventilation. The basic concept of NIPPV, thus, is the application of positive pressure during the respiratory cycle (inspiration and expiration). As technology has advanced, so have the devices and the techniques that control how the delivery of pressure (mechanical breaths) are started (triggered), controlled (targeted), and ended (cycled). Thus, numerous modes of NIPPV are available, which include:
· CPAP: The simplest application is that of ‘continuous positive airway pressure’ through the respiratory cycle, which is commonly called CPAP.CPAP is used in treatment and management of:
o Obstructive sleep apnoea
o Sleep-disordered breathing associated with congestive heart failure
o Acute pulmonary edema
o Coexistent obstructive sleep apnea and obesity hypoventilation syndrome (OHS)
o Overlap syndrome (coexistentsleep apnea and chronic obstructive pulmonary disease)
· BPAP: Bi-level positive airway pressure or BPAP, switches between a higher inspiratory positive airway pressure (IPAP) and a lower expiratory positive airway pressure (EPAP), thus mimicking normal respiration, by maintaining alveolar ventilation, reducing the work of breathing, unloading the respiratory muscles, lowering diaphragmatic pressure swings, reducing respiratory rate, and eliminating or supporting diaphragmatic work. It is usually used for ventilatory support in patients with acute respiratory failure
· Volume-assured pressure support: In these devices, a target tidal volume or alveolar ventilation is set, and the device adjusts the pressure support to reach that target. The advantage of this mode is that it guarantees a delivered tidal volume despite variability in patient effort, airways resistance and lung or chest wall compliance.
It is hard to say that which the best pulmonary hospital in India is, but you can find one of the best treatment for diseases of the lungs and respiratory tract, pneumonia, chronic bronchitis and asthma at Paras Hospital Darbhanga. This hospital in Darbhanga, is a multi-facility, super-specialty hospital which has numerous specialized departments including one of pulmonology, where NIPPV is available, along with the leading pulmonology specialist in Darbhanga.