|Define Hypoxemic Respiratory Failure.||the inability to maintain norm oxygen in art blood: P/F ratio<300; PaO2<60mmHg w/
|Pt receives NPPV for hypoxemic
||No more than 1-2 hours. If pt declines w/in first 30 mins, don’t wait.|
||1)immunocompromised 2) awaiting transplantation 3)post lung resection|
|Name 3 other indications for the use of NIV therapy in acute care||1)DNI orders 2)Facilitate weaning for COPD & CHF 3)Post-opt in abdominal surgeries|
|Name 5 Restrictive Thoracic Diseases (RTD) for which NPPV is used in chronic care||Post
|What are 3 benefits gained by NPPV in Restrictive Thoracic Diseases||1)Improved lung
|Name 6 predictors of successful
||1)low severity illness 2)Resp Acid PCO2 45-92 3)pH 7.22-7.35 4)min air leak 5)rapid improved gas x-change (30min-2hrs) 6)improved RR & HR|
|What 3 types of ventilators are used for NPPV||Non-invasive
|Name 4 disadvantages of full face mask vs. nasal mask||1)increased dead space 2)risk of aspiration 3)claustrophobia 4)diff communic./expectorate|
|What % of acute respiratory failure patients should start w/ full face mask?||90%|
|Name the 5 patient Interfaces used w/NPPV||Nasal
|Name the selection criteria for NPPV in care of Acute Respiratory Failure||2+ present: Paradoxical breath;access muscle use;RR>25;dyspnea;PaCO2>45;pH<7.35;P/F<200|
|Name the exclusion criteria for NPPV in care of Acute Respiratory Failure||copious secretions;hemodynamic instability; apnea;face burns/trauma;
|Name the 4 ways NIV can be provided||Negative Pressure
|How is NPPV typically administered?||Nasal or oral/nasal mask|
|What condition must be present to add NPPV therapy with CPAP in Acute Pulm Edema?||Hypercarbia (ventilatory failure)|
|Name the 3 “constant” end expiratory pressures that support oxygenation (all mean
||CPAP, EPAP, PEEP|
|What is the 1st line therapy for Acute Pulmonary Edema?||CPAP 8-12 cmH2O w/ 100% oxygen|
|What is the standard of care in patients w/ acute COPD exacerbations?||NPPV (as an alternative to intubation & conventional mechanical ventilation)|
|Name the 5 goals of NPPV in the chronic care setting||1)avoid hospital 2)increase survival 3)relieve symptoms 4)improve mobility 5)enhance life|
|What is the application of positive pressure w/o intubation to augment alveolar ventilation||Non-invasive Positive Pressure Ventilation
|what is a rubber bladder strapped around the abdomen, when inflated assists w/ inp & exp||Pneumobelt|
|What is the device that rocks from Trendel-enburg position to reverse to aid breath||Rocking Bed|
|Which mode of ventilation re-establishes FRC and recruits alveoli?||EPAP (or CPAP or PEEP)|
||cognitive dysfunction;headache;fatigue; dyspnea; daytime hypersomnolence|
|NPPV for pt w/ severe COPD & signs of nocturnal hypoventilation must also have (3):||1)PaCO2>55mmHg 2)PaCO2 50-54mmHg PLUS noc-turnal desaturat 3)2+ hosp for ventilatorfail|
|When IPAP is increased…||…Tidal Volume increase, Ventilation increases, and PaCO2 decreases|
|When EPAP is
||…Tidal Volume decreases, PaO2 increases, and FRC increases|
|When rate control is increased…||…Minute Volume increases, PaCO2 decreases|
Egan’s Chapter 45 Practice Questions:
A nasal mask
B nasal mask that is one size larger than normal
C nasal pillows
D full face mask
2. A 57-year-old woman with a 45 pack-year smoking history and a barrel chest arrives in the emergency department complaining of shortness of breath. She is using pursed-lip breathing. Her arterial blood gas on a 2L/min nasal cannula is pH = 7.26 , PaCO2=64mmHg, PaO2=50mmHg, and HCO3=36mEq/L. Which of the following ventilators would you select?
A intubate and use a critical care ventilator
B noninvasive ventilator
C critical care ventilator
D portable volume ventilator
3. A 67-year-old man had a surgical repair for a perforated gallbladder with peritonitis one week ago. He was extubated earlier in the day, but he presently has a respiratory rate of 32 breaths/min, is diaphoretic, and is using accessory muscles to breath. His ABGS on 60% O2 aerosol is pH= 7.40 PaCO2= 31mmHg PaO2= 71mmHg and HCO3= 19mEq/L. Which of the following action is most appropriate?
A use only CPAP to improve oxygenation
C intubate the patient if there is not significant improvement within 1 to 2 hours
D use a nasal mask to decrease risk of claustrophobia
4. After Mr. Pierre adjusts to the initial feel of NPPV, which of the following settings would you like to achieve?
A IPAP= 14cm H2o, EPAP= 8cm H2O FiO2= 0.60
B IPAP= 8cm H2O, EPAP= 4cm H2O FiO2= 0.40
C IPAP= 10cm H2O, EPAP= 8cm H2O FiO2= 0.50
D IPAP= 8cm H2O, EPAP= 6cm H2O FiO2= 0.40
5. After Mr. Pierre is breathing for 10 minutes on his new NPPV settings, you see the following image on his ventilator graphics. Which of the following changes would you make?
B adjust the trigger sensitivity
C adjust the termination of flow
D no changes are necessary
6. All of the following types of patients could benefit from noninvasive positive-pressure ventilation except:
C neuromuscular weakness
D weaning from mechanical ventilation
7. Mr. Pierre has been on his NPPV for the past 2 hours. His respiratory rate is 26 breaths/ min with moderate accessory muscle use. After viewing his arterial blood gas values on FiO2= 0.50, which of the following would you recommend?
A maintain current setting
B increase IPAP by 2cm H2O
C increase the FiO2 to 0.60
D reintubate and use invasive ventilation
8. Noninvasive CPAP is indicated for which of the following?
A hypercarbia respiratory failure
B hypodermic respiratory failure
C acute cardiogenic pulmonary edema with hypoxemia only
D postpolio syndrome
9. The physician recommends a trial of noninvasive ventilation before reintubation. Which of the following ventilators would you plan to use?
A noninvasive ventilator
B critical care ventilator
C portable volume ventilator
10. Where would you set the initial IPAP and EPAP levels as you help Mr. Pierre adjust to the NPPV?
A IPAP= 12cm H2O, EPAP= 8cm H2O
B IPAP= 10cm H2O, EPAP= 6cm H2O
C IPAP= 4cm H2O, EPAP= 2cm H2O
D IPAP= 8cn H2O, EPAP= 4cm H2O
11. Which of the following actions will improve patient synchrony during NPPV?
A change the interface to reduce leaks
B increase the time-cycle to 1.2s
C initiate volume-controlled ventilation
D coach the patient to inhale more deeply
12. Which of the following best describes the type of respiratory problem Mr. Pierre is likely experiencing?
A hypoxemia respiratory failure
13. Which of the following practices would help your patient adjust to NPPV best?
A use a nasal mask so that the patient can easily communicate
B select a high IPAP setting to immediately help the patient catch her breath
C strap the mask securely in place to prevent air leaks
D hold the mask in place with your hands until the patient adjusts to the gas flow
14. Which of the following statements about noninvasive ventilators is true?
B the ventilators have an external exhalation valve
C the inner lumen of the circuit must be completely smooth
D rebreathing carbon dioxide may occur at high EPAP levels: The inner lumen of the circuit must be completely smooth
15. Which of the following statements about noninvasive ventilatory support is true?
A The negative pressure change causes exhalation with negative pressure ventilation
B inflating the bladder on the
C rocking into
D the positive pressure in noninvasive positive-pressure ventilation inflates the patient’s lungs
16. Which statement related to improving patient comfort with NPPV is correct?
A heated humidification should be added to all NPPV breathing circuits
B a rise in pressure at the end of inspiration in a pressure-controlled breath indicates an increased work of breathing
C all critical care ventilators can adjust for leaks as well as noninvasive ventilators
D nasal mask work equally as well as full face mask
17. Which type of interface would you select for Mr. Pierre?
B total face mask
C full face mask
D nasal mask
18. How is Noninvasive ventilation abbreviated for this class?: NIV
19. NIV use has increased due to what?: improved patient interfaces, Improved quality of NIV ventilators, NIV software available for critical care ventilators, Reports of success in literature
20. Normal PF Ratios/indications: Normal: 500, <300 NIV, <200 ARDS
21. NVI indicated for physical diseases??? SAY WHAT?: Post polio, NMD, chest wall deformities, spinal injuries and severe kyphoscoliosis can benefit from NVI. (helps to rest breathing muscles, lowering CO2 & Deadspace and increasing Compliance and FRC.
22. something about a
23. What are key attributes to the
24. What are key points of NIV?: Supports ventilation without artificial airway, earliest example being bag-mask.
25. What does NIV encompass?: Ventilation and CPAP, typically provided by
26. What is a chest cuirass:: Therapeutic Godzilla Hickey
27. What is an example of a Negative-Pressure ventilator?: Iron Lung
28. What is IPAP-EPAP?: Pressure support
29. What is the primary indication for noninvasive ventilation?: Hypercapnic respiratory failure due to COPD. (Standard of care for managing an acute exacerbation of COPD *FIRST LINE THERAPY*)
30. What other conditions benefit from NIV?: Asthma, Acute cardiogenic pulmonary edema, Hypoxemic respiratory failure
31. What other patients should NVI be considered for?: DNI (Do not intubate) patients, Postoperative patients, patients in need of weaning facilitation (CHF and COPD patients). Nocturnal hypoventilation
32. Why use NIV for Hypercapnic respiratory failure due to COPD?: Strong evidence in reducing the need for intubation, Hosp mortality and length of stay.
33. Chest Cuirass: A device to deliver negative pressure ventilation that only fits over the thorax.
34. hypoxemic respiratory failure: The inability to maintain the normal oxygenation in the arterial blood. It may be indicated by a PaO2 of less that 60 mm Hg in individual breathing supplemental oxygen.
35. Inspiratory Positive Airway Pressure (IPAP): Pressure that is applied during the inspiratory phase of mechanically assisted ventilation.
36. Iron Lung: A full body negative pressure ventilator.
37. negative-pressure ventilator: An approach to ventilation in which negative pressure is intermittently applied to the chest surface in an effort to cause inflation of the lungs.
38. nocturnal hypoventilation: Nocturnal Hypoventilation Syndrome is related to sleep apnea, but is due to the brain’s respiratory control center not sending out enough nerve impulses to the breathing muscles. So, rather than the breathing being stopped by obstruction to the upper airways behind the tongue (as with OSA), there simply is not enough breathing and sometimes complete cessation of breathing.
39. noninvasive positive pressure ventilation (NPPV): A positive-pressure ventilation without endotracheal intubation or tracheotomy, usually via a form-fitting nasal mask.
41. Rocking bed: A bed that rocks back and forth moving the abdominal contents up and down facilitating inspiration and expiration.
42. Trendelenburg position: A position in which the head is low and the body and legs are on an inclined plane