Technical knowledge (theoretical and practical)
Medical coordinator – staff/patient interaction
Medical coordinator – staff/ventilator interaction
Ventilator/patient interactions
Other variables
Indications/contraindications for NIV
Intubation and mechanical ventilation criteria
NIV physiopathology
NIV mechanisms
NIV particularities according to diagnosis
Treatment aims
Alarm signs
Adequate Bilateral communication – understanding and meeting patients’ needs
Getting across a sense of safety and reassurance to the patient
Early identification of alarm signs
Knowledge of available ventilators (potential and limitations, advantages and disadvantages)
General ventilator maintenance
Ventilation modes
How to manipulate the ventilator
How to adjust settings
Interpreting data and pressure/flow waveforms
Assure patient comfort
Causes of disadaptation
Patient/ventilator asynchrony
Adjusting:
Mask and headgear
Leaks
Trigger/cycling
Humidification
Staff capabilities and limitations
Staff’s confidence in NIV results
Patient profile
Proximity to the ICU
Doctors, nurses, and physical therapists may share a common background but should develop specific skills according to their activities in the NIV team. Differentiated training and education according to the role played by each staff member is desirable and may make a difference in critical patients. Once again, the content and the duration of what is considered an adequate training program have not been defined. As a general rule, each NIV center has developed its own training programs according to what is considered locally needed.
98.3 Current Evidence on Staff Training in NIV
When handling a patient with either acute or chronic respiratory failure, NIV – mainly positive pressure NIV – may be among several treatment options available to a medical team. Having its benefits widely identified in specific settings, its generalized use should not be taken lightly.
NIV treatment consists of a complex network where the main actors – the patient, the medical coordinator, staff (including doctors, nurses, and physical therapists), and the NIV in itself – are dynamically interrelated (Fig. 98.1). Each intervenient plays its specific role during this procedure, and the resulting method of ventilation contributes largely to the patient’s acceptance and compliance with this treatment option, which is essential for a positive outcome [3].
Fig. 98.1
Network of intervenients in NIV and respective interrelationships. Although successful patient treatment is the main aim of this network, the medical coordinator holds the central role in its attainment, observing, receiving continuous feedback, and coordinating all activity leading to NIV success and better patient outcome
Staff training and expertise in NIV are essential for successful NIV treatment, especially in the acute hypercapnic respiratory failure (AHRF) setting. However, medical and paramedical expertise is generally difficult to evaluate and has been poorly studied, including in NIV [4].
The complexity and subtlety of NIV demand generalized knowledge, both theoretical and practical, of several aspects of this treatment modality. It seems logical to assume that respiratory physiopathology, NIV basic knowledge, and updated NIV guidelines are the essential pillars on which all NIV techniques may be developed with regular clinical practice.
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