Question Answer
What is CPAP? A Constant pressure applied to the spontaneously breathing patient.
CPAP is applied via a mask-type device
CPAP Does not provide volume change or support in patient’s minute ventilation
What are the indications for CPAP? Treats OSA Improves Oxygenation
What does NPPV do? Pressure is applied intermittently with inspiration having a higher pressure than expiration.
NPPV is applied via a mask type device
What are the indications of NPPV? Acute respiratory failure chronic respiratory failure
NPPV provides greater flexibility in initiation and removing mechanical ventilation
NPPV permits normal eating, drinking and communication with the patient
NPPV preserves airway defense, speech and swallowing mechanisms
NPPV avoids trauma associated with intubation, the complications associated with artificial airways
NPPV reduces the risk of VAP
NPPV reduces the risk of ventilator induced lung injury associated with high ventilating pressures
NPPV reduces muscle work and helps to avoid respiratoyr muscle fatigue that may lead to acute respiratory failure.
NPPV provides ventilator assistance with greater comfort, convenience, and less cost than invasive ventilation
NPPV reduces requirements of heavy sedation
NPPV reduces the need for invasive monitoring
What are some contraindications of NIV? Respiratory arrest(apnea) or the need for immediate intubation, Unable to protect the airway, excessive secretions, hemodynamic instability, agitated and confused patients, parodoxical breathing, uper airway obstruction.
What are some other contraindications of NIV? Facial deformities or conditions that prevents mask fit,untreated pneumothorax, uncooperative of unmotivated patients, brain injury with unstable resp. drive, major organ damage (sever hemorrhaging), recent gi surgery, irreversibility of disorder.
What are devices that can be used to provide NIV? Nasal Masks Full Face Masks Nasal Pillows Nasal Cushions Total face mask
When fitting the nasal mask you should choose the smallest mask without obstructing the nostrils.
Where are anatomic leaks with the nasal mask? sides of nose bridge of nose above the lip
For the nasal mask the top of the mask is placed just above the junction of the nasal bone and the cartilage
The nasal mask should not be pinching the nose at the side
The lower part of the nasal mask should fit just above the upper lip
A common error in fitting the nasal mask is choosing a mask that is too large
What attaches to the end of the mask and rests on the forehead and helps reduce pressure on the bridge of the nose? Foam bridges
What are the advantages of nasal masks? Less risk of aspiration Enhanced secretion clearance less claustrophobia easier speech less dead space
What are disadvantages of the nasal mask? Mouth Leak Less Effectiveness with nasal obstruction Nasal irritation and rhinorrhea mouth dryness
Full face masks are most often successful in the critically ill population
The pressure pick off port allows a pressure manometer to measure pressure.
The ball and socket clip (escape clips) allow for easy mask removal
A full face mask surrounds the nose and mouth and rests below the lower lip.
What are the landmarks for a full mask? Below the lower lip with mouth open. Corners of the mouth. Just below the junction of nasal bone and cartilage.
Full face masks should fit even if the patients mouth is slightly open
You should be sure the mask fits well and does not leak excessively particularly not in the eyes.
Full face masks are most effective for dyspneic patients
What are the disadvantages of a full face mask? increased deadspace difficulty in maintaining seal increased risk of pressure sores claustrophobia increased aspiration risk difficulty with speech inability to eat with mask on difficulty with secretion clearance possible asphyxiation with vent
Nasal pillows or nasal cushions are suitable for patients with claustrophobia skin sensitives need for visability
How do you fit a nasal pillow or nasal cushion? plastic size gauge is inserted in each nostril.
Sometimes leaks are caused by the mask not being correctly seated on the face
Some leaks may be caused by excessive tension of the head straps
headgear tension should allow 1-2 fingers between the head straps and face
In patients withou a full set of teeth using a full face or total face mask can help minimize leaks
Vented masks require a vent for exhalation and use only one corrugated tube to connect to the ventilator.
Nonvented masks have both an inspiratory and expiratory line
In a nonvented mask exhaled volumes, flows and pressures can be monitored.
What are complications associated with NIV? Hemodynamic instability risk of aspiration claustrophobia gastric insufflation/distention Use of NG tubes eye irritation poor sleep quality nasal or oral dryness/congestion sinus or ear pain skin problems
The battery only works alarms for 2 minutes and does not support operation of the machen
For the vented system use a filter
The BIPAP Vision can be used invasively unlike others
Leak compensation intentional (vents) unintentional (patients)
The check vent alarm is the yellow eye
The vent inop is the red wrench and can continue to use but will eventually shut down.
The alarm pannel has 8 hard keys 10 soft keys and 1 knob
The self test takes 15-30 seconds when powered on
The exhalation port test checks for intentional leak
It is set in %
The fio2 is +- 10%
The patient leak is unintentional leak
% triggered is the number triggered compared to total triggere
% trigger is active in S/T mode an calculates over 30 minutes time
The typical ipap setting is 8-12 cmh20 It can be adjusted to change VT
The typical EPAP setting is usually started out at 4 and can be increased to improve oxygenation
The desired fi02 is set
The Learn base flow usually learns automatically
It must be performed if 02 is added at mask or a neb is given (any time extra flow is introduced) takes 2 minutes and will not hurt function of the unit
The set rate or back up rate must be set
Rise time determines how fast the vent rises from baseline pressure to target pressure
The high and low pressure alarm must be set +/- 5 if S/T mode is ued
The low pressure delay allows time for EPAP to IPAP usually set at 10 seconds
The low minute ventilation is usually set at 10-20% below patients baseline
The high and low rate alarm must be set
Apnea alarm will alarm if it does not recognize a spontaneous breath
The air leak should be 7-25 L/M for a good fit
The air leak that is 0-6L/M indicates a mask that is too tight
If the air leak is 26-60 L/Minute The mask must be adjusted and monitored
The display flashes with a flow variation of greater than 15 L/Min and has an accuracy of +/- 10%. It allows titration of pressure support and indicates changes in patient status.
The tidal volume/minute ventilation is a running average of the last 6 breaths
TI/Ttot is inspiratory time to total cycle time
The Ti/Ttot helps to evaluate respiratory muscle endurance
if the Ti/Tot is less than 30 it indicates improvement and (IPAP can be decreased)
If the Ti/Ttot is greater than 40% indicates fatigue (increase IPAP)
The normal value for Ti/Ttot is 30-40%
% patient triggered breaths is calculated over a 30 minute period and is updated every minute. It is active only in S/T mode It assesses dependence on the vent Determines readiness to wean.
Question Answer
What is IPPB and approx. how long does an IPPB treatment last? A specialized form of NIV. 15 minutes.
What is IPPB used for and what is not used for? Used for: provides machine assisted deep breaths assisting the pt to deep breath and stimulate cough. Treats atelectasis. Not used for: To provide full ventilatory support.
What patients should be considered for LET using IPPB? 1. For pts with atelectasis who are unresponsive to other therapies. 2. Pts who are at high risk for atlectasis and are unable to use other treatments.
Which condition should IPPB not be used as a single modality treatment and why? Gas absorption atelectasis because of excessive airway secretions.
What is the one absolute contraindication for IPPB? Tension pneumothorax
11 contraindications for IPPB. ICP <15MM Hg hemodynamic instability active hemoptysis tracheoesophageal fistula recent esophogeal surgery active/untreated TB radiographic evidence of blebs recent facial,oral,skull surgery hiccups nausea air swallowing
Most common complication of IPPB? Respiratory Alkalosis from pt hyperventilating during tx. Which decreeases PCO2 and increases pH.
How does gastric distention occur? When gas from the IPPB devices passes directly into the esophagus at pressures of 20 to 25 cm H2O
What type of pt is gastric distention uncommon in? Alert patients
Gastric distention is a significant risk for what type of pt? Pts who are neurologically obtunded
Gastric distention represents the greatest risk with what patients? Patients receiving IPPB at high pressures
12 Hazards of IPPB Increased AWR/WOB Barotrauma,pneumothorax nosocomial infection hypocarbia gastric distention impaction of secretios psychologic dependece impedance of venous return exacerbation of hypoxemia hypo/hyper ventilation increased VQ mm Air trapping
Preliminary planning for IPPB planning includes what 3 things? I. evaluating alternative approaches to the patient’s problem II. setting specific, individual clinical goals or objectives III. conducting a baseline assessment of the patient
7 desired outcomes for IPPB Improved VC Increased FEV1 Enhanced cough/secretion clearance Improved chest radiograph Improved BS Improved oxygenation Favorable pt subjective response
The general assessment common to all pts for whom IPPB is ordered should include what 3 things? 1. measurement of VS 2. observational assessment of pts appearance/sensorium 3. breathing pattern/chest auscultation
What position(s) are ideal for IPPB? 1. For best results semifowler 2. Supine is acceptable when semifowler is contraindicated.
Optimal breathing pattern for IPPB? Slow deep breaths that are sustained or held at end inspiration which increases inspired gas to areas of the lung with low compliance specifically atelectasis areas.
Prior to starting IPPB on a new pt what 4 things should the RT explain? 1.The purpose of IPPB 2.Why the doctor ordered the tx 3.how it will feel 4.what are the expected results.
When checking pts IPPB breathing circuit before use, the device wont cycle off even when mthpc is occluded. What should you do? Check the circuit for leaks.
In order to eliminate leaks in an alert pt receiving IPPB which adjuncts should you try first? Nose clips. Mouthpiece must be inserted well past lips to prevent gas leakage from site.
When adjusting sensitivity control on IBBP device which parameters are you changing? Effort required to cycle the device “on” (begin inspiration)
What are appropriate initial settings for IPPB given to a new pt? Sensitivity level of 1-2 cm H2O. Pressure (5-10 cm H20) is set low enough for pt to be able to trigger the IPPB machine for insp. and exp. Flow should be low to moderate according to pts breathing pattern.
Which breathing patterns are most desirable for IPPB? 6 bpm with an exp. time 3-4 times longer than insp. time.
What are appropriate volume goals for IPPB? A volume of 10-15 ml/kg of body weight or at least 30% of the pts predicted IC.
In terms of machine performance what do large negative pressure swings in early inspiration indicate? An incorrect sensitivity setting.
What will make an IPPB device cycle off prematurely? I. airflow obstructed II. kinked tubing III. occluded mouthpiece IV. active resistance to inhalation
Why did the use of IPPB decline in the 1980s? Due to the lack of scientific evidence to support its use for delivering aerosolized medication.
What are the 9 goals of NIV in the acute care setting? Improve gas exchange.Avoid intubation, decrease mortality, length of time on vent, and length of hospital stay, and vent pneumonia. Relieve resp.dist. symptoms, improve pt-vent sychrony, and max. pt comfort.
Which therapies should be considered first line of therapy in patients with exacerbated COPD? NIV
What therapy should be tried first for a pt who has pulm. edema from left heart failure? CPAP
Which NIV settings are adequate for a pt with cardiogenic pulm. edema? Mask CPAP 8-12 cm H2O and 100% O2.
What are 3 benefits of CPAP in postop abdominal surgery. lower intubation, pneumonia, infection/sepsis rates
Which groups of pts are considered at risk for reintubation? COPD, CHF, hypercapnia
Which restrictive thoracic diseases(5) are successfully managed with NIV? 1.postpolio sysndrome 2.chest wall deformities 3.neuromuscular diseases 4.spinal cord injuries 5.severe kyphoscoliosis
How does NIV benefit (3) pt with restrictive thoracic diseases? 1.Resting muscles 2.Lowering CO2 3.improved compliance, FRC, and deadspace
The use of NIV in long term care pts with COPD will benefit the pt in what ways? 1. PIP improves gas exchange, unloads resp. muscles 2.reduces fatigue 3. decreases symptoms of nocturnal hypoventilation 4. and sleep disordered breathing, improves sleep quality and daytime gas exchange
Which groups of pts with nocturnal hypo-ventilation respond to NIV? Hypercarbic
What is least likely to indicate the need for the NIV pt? Jugular venous distention
Pt is being ventilaited with a nasal mask to relieve dyspnea, long history of COPD/hypercarbia. What is the goal of NIV with regards to ABGs? Return the PaCo2 to less than 60mmHg
What are the 4 contraindications for NIV? 1.Uncooperative pt 2.Lack of financial resources 3.non supportive family 4.copious secretions
What 2 interface(s) are most commonly used to apply NIV in the acute care setting? Nasal/Full face mask
Which of the following is a potential risk for over tigentening the straps on the mask? tissue necrosis
Which of the following interfaces should be used in greater than 90% of pts with hypoventilation? Full face Mask
Which 2 interfaces appear to be more efficient to improve ventilation? Nasal pillows/full face mask
Which interfaces that improve ventilation appears to be more tolerated? Nasal Mask
Which ventilators are not used for NIV? Negative pressure
What are 3 characteristics of most NIVs? 1.Microprocessor controlled 2.blower driven 3.electrically powered
What is the most important advanatage of NIV over other types of ventilators? Ability to trigger and cycle when small to moderate air leaks are present
3 Minimum performing characteristics of most NIVs? 1.Insp. presure 50cm H2O or less 2.peep of 15cm H20 or less 3.Insp.flow of 180L/Min or less at 20cm H2O
Required vent alarms for NIV 1. battery failure 2. circuit disconect 3.loss of power
Which level of PEEP is necessary to prevent re-breathing of CO2 3-5cm H2O
Patient is being ventilated with a common critical care vent using pressure support ventilation flow cycled with a nasal mask. A leak is present that is preventing the appropriate termination of the insp cycle. What is the best response? Switch to time cycled mode
What strategy should be used when the patient complains of nasal congestion during the use of a nasal mask for NIV? Add a heated humidifier
Which is the current recommendation for adding humidity while using NIV? Recommend for long term, longer than a day
What defines successful application of NIV? overall improvement of pts ABG, PaO2 increase PaCO2 decrease
Physiologic effect rasing the PEEP have in pt receiving NIV? Increase in FRC
Which is likely to occur when decreasing exp.positive airway pressure in the pt being ventilated using noninvasive ventilation? Increase in VT
Best option for pt in rsp. failure who continues to deteriorate 30 mins after the initiation of NIV? Intubate and begin mechanical vent
Most common complication associated with NIV? Air leaks
7 Exclusion criteria in NIV pts with acute resp. failure 1.apnea 2.inability to protect airway/high asp. 3.lack of pt coop. 4.mod to severe dyspnea 5.PaCO2 45mmHG Ph <7.35 PaO2/Fio2 <200 6.hemodynamic or cardiac instability 7.inability to use a NIV interface due to facial trauma, burns, or ab.anatomy
Predict the successful use of NIV in resp. failure pt. (5) 1.minimal air leak 2.low severity of illness 3.resp. acidosis 4.improv. of gas exchange w/in 30 mins to 2 hrs of initiation 5.improv. of HR and RR
Recommended initial setting for ventilating pressure when delivering NIV in pressure triggered time mode? 8-12 cm H20
Recommended intial setting for PEEP when delivering NIV in pressure triggered time mode? 5-8 cm H2O
Initiating NIV can be done in which settings? 1.any acute care setting 2.ED 3.ICU 4.General floor care
3 Techniques are useful to avoid claustrophobia in pt being ventilated by face mask. 1.allow to hold mask 2.increase insp. flow 3.use sedation
Which of the following 5 ways to correct a large air leak during NIV? 1. Adj. vent settings 2.use leak compensation 3.change termination criteria 4.use time cycled mode 5. adj. trigger sensitivity
5 Factors assoc. w/ pressure and flow related complications during NIV? 1.Nasal congestion 2.upper airway dryness 3.ear and sinus pain 4.eye irritation 5.upper gastric insuffaction
3 Modes commonly seen on NIV vents. 1. CPAP 2.Spontaneous (pressure support) 3.timed (pressure assist/control)
Indications for NIV where greatest controversy exists? Hypoxemic resp. failure
Statements about the use of home care vents for delivering NIV. 1.for pts who need cont.vent support or high ventilating pressures 2..single/double limbed vent circuit with exhalation valve 3..some compensate for leaks 4.recommended for pts who have severe chest wall deformities or obesity
Pt population only group currently accepted fo ruse of NIV in hospital ward? community acquired pneumonnia
What is required for noninvasive ventilators to work properly? Continuous air leaks through 1 or more ports in vent. circuit or patient interface.
What mode of ventilation is most often used for NIV when a critical care ventilator is in use? Pressure Support Ventilation (PSV)
Question Answer
What is BiPAP non invasive device that augments pt ventilation
What are the 2 levels of pressure IPAP and EPAP
On BiPAP which one is larger larger on insp ex 12/5
BiPAP is always spontaneous
IPAP increase the increments of 2 cmH20. used if there is a CO2 problem (ventilation)
EPAP increase in increments of 2 cmH20. Oxygenation problem, similiar to PEEP
Spontaneous pt triggers ALL inspirations which are pressure supported. You set IPAP and EPAP only. Pt determines RR, volume
S/T Pt determines volume, if pt does not breath, cycles to IPAP when time has elapsed.`
T cycles btwn IPAP and EPAP due to time intervals only. PT may take additional OWN breaths. You set IPAP, EPAP, BPM and % IPAP (like control mode)
CPAP mode pressure is set on continous, pt breaths on it’s own, pt is control of RR and volume, set EPAP only
indications for BiPAP resp failure, post surgical, hypoxemia due to hypoventilation, sleep apnea, vent muscle fatigue, upper airway obstruction, post extubation difficulties
contraindications for BiPAP pre existing pneumothorax, hypotension, pre existing bullous lung disease (emphysema), nose bleeding, aspiration, sinusitus
side effects of BiPAp pressure ulcers, claustophobic, eye irratiation
What do you adjust IPAP for ventilation problems
What do you adjust EPAP for oxygenation problems
Benefits of BiPAP can talk, non invasive, infection risk decreased, works in presence of leaks,
GOALS of BiPAP avoid intubation, pt mobility improvement, decrease VAP, improve gas exchange
IPAP initial setting 8-12 cmH20
EPAP initial setting 3-5 cmH20
Initial setting for oxygen match pt’s or titrate to obtain acceptable PaO2
initial settings for BPM 2-5 less than pt’s spontaneous rate
intitial settings for % IPAP usually 33-50% to deliver 1:2 or 1:1
If there is an increase in CO2 what do you do adjust IPAP to create greater pressure differences between IPAP and EPAP (this increases alveolar ventilation)
What to do if you have hypoxemia increase level of EPAP
IF unit stops and starts check power cord, check connection
if there is no air flow from unit check voltage selector switch, possible internal problem
unit runs but light not activated replace light
How many sets on BiPAP 2, CPAP and S/T
What do you want to set RR on 4-40 bpm
What do you want to set IPAP on 4-40 cmH20
What do you want to set EPAP on 4-20 cmH20
What does the exhalation port do directs air. Exhale goes through port so pt doesn’t rebreath their CO2
What does the exhalation port test do anaylyzes leak rate of exhalation port.
Pt flow triggered breaths are flow cycled
Time triggered breaths are time cycled according to the set insp time
How should the mask fit from the bridge of the nose to just below the nares… make sure the mask rests above the upper lip
What is the whisper swivel designed to exhaust CO2 from pt’s circuit
Pt’s tidal volume should be 20% greater than what they are doing
Pt with chronic hypercapnia IPAP should be adjusted to maintain an acceptable pH NOT normalize the PaCO2
Question Answer
The IPAP will always be Higher than the EPAP
On CPAP what will pressure do be constant during inhalation and exhalation
If you have ventilation problems you adjust IPAP
If you have oxygenation problems you adjust EPAP
What do you set on spontaneous mode EPAP and IPAP only
what do you set on timed mode IPAP, EPAP, BPM, and % IPAP
What is the purpose of an BiPAP to augment pt ventilation by supplying pressurized air through a mask
The pt’s effort and difference btween IPAP and EPAP determine Tidal volume
The time intervals on TIME mode are determined by RR and insp time (% IPAP) controls The pt can take their own breaths over the timed ones
IPAP control 4-40
EPAP control 4-20
Rate control 4-40
CPAP control 4-20
Timed insp 0.5-3.0 seconds
IPAP rise time .05-.40 seconds
oxygen % 21-100
If pt is hypoxemic increase the level of EPAP
If the pt has increased CO2 adjust the IPAP to create pressure difference between IPAP and EPAP
Typical initial setting of EPAP 3-5
Typical initial setting of IPAP 8-12
Which mask improves the tidal volume the most full face mask
Question Answer
What is ideal breathing pattern for SMI, IPPB, Aerosol therapy, ect slow, deep inspiration, inspiratory pause/hold 1-3 sec, exhalation is slow passive and relaxed, pt may relax in between maneuvers with normal tidal volume breathing
How do you position a pt for breathing techniques prone for ARDS, fowlers for CHF, lateral fowlers for the obese pt, good lung down for unilateral lung disease
Ventilatory muscle training benefits pt by increasing their muscle strength and endurance, decreaseing dyspnea, the need for medication and hospital visits
What are the indications for SMI, incentive spirometry prevention of atelectasis
How do you perform SMI hourly while the pt is awake for 10 breaths, date time and volume should be charted but not duration, increase or decrease volume goals based upon pt performance
What are the indications for IPPB prevent atelectasis, prevent or decrease pulm edema, decrease work of breathing, mechanical bronchodilation, distribute aerosols, manipulate of insp-exp pattern, improve alveolar collateral ventilation and cough mechanism
What are the contraindications of IBBP unskilled practitioners and users, massive pulm hemorrhage, untreated pneumo, dirty equipment
What are the hazards of IBBP hyperventilation, impeding venous return, gastric distention, pneumothorax, excessive oxygenation and increased air trapping in COPD pt, active tuberculosis
What is the Bird Mark 7 positive pressure, pneumoatically powered, time triggered, pt triggered, pressure cycled, assist and control modes, flow adjustable
In a Bird Mark 7 flow rate control what ratio is adjustable I/E ratio, increasing the flow will increase the E time and decreasing the flow will increase the I time
In a Bird Mark 7 air-mix off will give 100% source gas setting, flow rates are reduced because room air is not entrained, must increase flow setting when changing to 100% source gas setting
In a Bird Mark 7 air mix on will give oxygen concentration between 40-80%
In a Bird Mark 7 what happens under pressure volume is changed by adjusting the pressure limit, max pressure 60 cmH2O, leaks in the circuit will prevent normal cycling to exhalation, obstruction/coughing would prematurely end inspiration
In a Bird Mark 7 what happens under sensitivity higher the number indicates increased pt effort decreased sensitivity, lower number indicate decreased pt effort increased sensitivity
What is a Bennett AP-4 and AP-5 Ventilators positive pressure, electrically powered, compressor driven, pt cycled assist mode only, flow limited, pressure limited, appropriate for IPPB therapy in a home setting
Control changes that effect the FIO2 when the airmix is on and ventilator is powered by 100% O2, if you increase pressure then increase FIO2
Control changes that effect the FIO2 when the airmix is on and ventilator is powered by 100% O2, if you decrease flow increased inspiratory time will increase FIO2
Control changes that effect the FIO2 when the airmix is on and ventilator is powered by 100% O2, if the air mix is off then increase FIO2 to 100%
Control changes that effect the FIO2 when the airmix is on and ventilator is powered by 100% O2, the use of a nebulizer will increase the FIO2 on PR-11
Control changes that effect the FIO2 when the airmix is on and ventilator is powered by 100% O2, the use of terminal flow on PR-11 will decrease the FIO2
Control changes that effect the FIO2 when the airmix is on and ventilator is powered by 100% O2, sensitivity has no effect on the FIO2
Control changes that will change the Volume, increasing the pressure will increase the volume
Control changes that will change the Volume, decreasing the flow will increase the volume increased inspiratory time
Control changes that will change the Volume, increasing the flow will increase turbulence and decrease volume decreased inspiratory time
Control changes that will change the Volume, airmix and sensitivity have no effect on volume
Control changes that effect the I:E ratio, increased pressure or increased tidal volume will increase the inspiratory time and therfore change the I:E ratio
Control changes that effect the I:E ratio, increased flow will decrease the inspiratory time and change the I:E ratio
Changes in delivered volume with changing comliance and RAW, decrease compliance decrease volume
Changes in delivered volume with changing comliance and RAW, increase compliance increase volume
Changes in delivered volume with changing comliance and RAW, increase RAW decrease volume
Changes in delivered volume with changing comliance and RAW, decrease RAW increase volume
Changes in delivered volume with changing comliance and RAW, decrease compliance increase resistance decrease volume
Changes in delivered volume with changing comliance and RAW, increase compliance decrease resistance increase volume
Trouble shooting in pressure cycled ventilators if there is a loss of pressure leak, not enough flow
Trouble shooting in pressure cycled ventilators if there is excessive pressure obstruction, too much flow
Trouble shooting in pressure cycled ventilators if it fails to cycle into inspiration adjust sensitivity, tight seal around mouthpiece
Trouble shooting in pressure cycled ventilators if it fails to cycle off leak, mouth piece/mask seal, cuff leaking, fenestrated trach tube open, loose equipment connection
When do you use non invasive positive pressure ventilation neuromuscular disease, central/obstructive sleep apnea
What are the hazards of NPPV poorly fitting mask, irritation or ulceration from mask, leaks around mask or in tubing, gastric distention from high pressures
When is NPPV contraindicated pt with dysphagia
What is EPAP same as CPAP and can be used to improve oxygenation or prevent airway closure in obstructive sleep apnea
What is IPAP when this mode is set at a higher pressure than EPAP then positive pressure will be applied during inspiratory phase, maintain patent airway in obstructive sleep apnea
What is spontaneous/Timed (ST) allows pt to breathe at a spontaneous rate with combined timed breaths as in SIMV, IPAP phase will deliver inspiratory assist and EPAP will provide continuous positive airway pressure during exhalation
What is spontaneous/Timed (ST) controlled by selecting a respiratory rate and an inspiratory time percent
When using the timed mode of support for NPPV the pt cannot trigger additional mandatory breaths
A patient with uncomplicated obstructive sleep apnea will generally find relief with EPAP pressures of 5-10 cmH2O
Patients with neuromuscular disease will usually do well with inspiratory pressures of 10-15 cmH2O
Maximum pressure of 15-22 cmH2O may be necessary to achieve adequate alveolar gas exchange
During repiratory support oxygen must be titrated into the mask to achieve a desired FIO2
What is BIPAP bilevel positive airway pressure, non invasive ventilator
What are the two levels of CPAP in BIPAP IPAP one during inspiration, EPAP one during exhalation, IPAP (ventilation)should be greater than EPAP (oxygenation)
BIPAP ventilator breaths are flow triggered and require pt effort to be greater than 40 ml/sec to initiate inspiration
In BIPAP what I:E ratio is preferred 1:2
In BIPAP what is the maximum inspiratory pressure 22 cm H2O
During BIPAP the ventilator cannot provide adequate support for a pt with high airway resistance or low lung compliance
In BIPAP during operation the IPAP is the inspiratory pressure needed to abolish hypopnea and desaturation
In BIPAP during operation the EPAP is the expiratory pressure needed to keep the airway open
When is BIPAP contraindicated pt with dysphagia