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Noninvasive Ventilat
Bipap Vision
| 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. |
Created by:
kparkerlehman
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