Which of the following conditions is an indication for application of noninvasive ventilation (NIV)?

a. The patient requires low concentrations of supplemental O2.
b. The patient cannot swallow without the risk of aspiration.
c. The patient's peak cough flows are less than 3 L/sec.
d. Because of facial trauma, an airtight mask seal is impossible.

ANS: A
Any individual requiring mechanical ventilation can be supported with NIV if:
1. The patient is mentally competent, cooperative, and not using heavy sedation or narcotics.
2. Supplemental O2 therapy is unnecessary or minimal.
3. SaO2 can be maintained above 90% by aggressive airway clearance techniques.
4. Bulbar muscle function is adequate for swallowing without potentially dangerous aspiration.
5. No history exists of substance abuse or uncontrollable seizures.
6. Unassisted or manually assisted peak expiratory flows during coughing exceed 3 L/sec.
7. No conditions are present that interfere with NIV interfaces (e.g., facial trauma, inadequate bite for mouthpiece, presence of nasogastric tube, or facial hair that can hamper airtight seal).