Ongoing monitoring and optimisation of NIV
How often should patients be followed up after being initiated on NIV?
Patients should be monitored regularly, ideally every three days until the patient is established on the NIV and then every three months as a minimum. The timing of monitoring will vary depending on patient need.
How should I monitor patients using NIV?
Monitoring should assess adherence, tolerance and effectiveness and should involve a variety of methods such as telephone calls, face-to-face assessments or home visits, and patient diaries. It is important to gain self-report feedback from the patient but you should also use objective measures such as telemonitoring using the ventilator plus a modem as this reduces the need for face-to-face contact and travelling by the patient to the clinic.
What are some of the common problems to look out for and how can they be resolved?
There are a variety of problems that can impact on the adherence and effectiveness of the NIV. For example, problems with the mask such as mask leak, ventilator asynchronies, excessive secretions, obstructive events.
My patient is becoming more dependent on NIV, how should I manage this?
With increased dependency, patients often use the NIV both during the day and at nighttime. Some patients have different set-ups for daytime and nighttime use. It is important to ensure that patients and carers have access to a sufficient amount of equipment including back-up equipment in the event of equipment or electricity failure.
You will need to also provide patients with additional masks and different types of masks to accommodate their needs at different times. It is also important you discuss and plan with the patient, family and multidisciplinary team the likelihood of future deterioration.