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  • Print publication year: 2010
  • Online publication date: July 2010

Chapter 42 - Traumatic brain injury

from Section III: - Organ dysfunction and management


The applications of non-invasive ventilation (NIV) include: acute exacerbation of chronic obstructive pulmonary disease (COPD) and cardiogenic pulmonary oedema, for immunocompromised patient, during failure to wean from ventilation. It is essential before NIV is initiated that arterial blood gas measurements be available. The patient should be established upon appropriate oxygen therapy and interpretation must be made in the context of the FiO2. Correct patient selection is essential for the success of NIV: it is a complementary not alternative therapy to IPPV. The successful instigation of NIV is very dependent upon establishing a good rapport with the patient and inspiring confidence in what will feel like a very unusual treatment. The complications of NIV include mild gastric distension, pressure effects of the mask and straps causing facial tissue damage, eye irritation, sinus pain or nasal congestion, and significant haemodynamic effects resulting from NIV that are unusual although hypotension may occur.

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Further reading

Brain Trauma Foundation (2007) Guidelines for the management of severe traumatic brain injury, 3rd edn. J. Neurotrauma 24 (Suppl. 1): S1–S106.
HelmyA, VizcaychipiM, GuptaA (2007) Traumatic brain injury: intensive care management. Br. J. Anaesth. 99: 32– 42.
National Institute for Clinical Excellence (2007) Triage, Assessment, Investigation and Early Management of Head Injury in Infants, Children and Adults, NICE Clinical Guideline no. 56. London: NICE.