Chapter 7 Noninvasive Positive Pressure Ventilation
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| noninvasive positive pressure ventilation provides | assisted ventilation without an artificial airway
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| NPPV may be used to assist patients with | obstructive sleep apnea and acute ventilatory failure
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| NPPV provides ventilation via | the patients nose or mouth without an artificial airway
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| NPPV is | Noninvasive positive pressure ventilation
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| NPPV is ventilation without | an artificial airway
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| NPPV may be used as | CPAP or bilevel PAP
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| CPAP is | Continuous positive airway pressure
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| CPAP uses | positive airway pressure during spontaneous breaths
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| CPAP does not use | mechanical breaths
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| CPAP is active | when IPAP = EPAP
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| Bilevel PAP is | Bilevel positive airway pressure also known as BiPAP
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| BiPAP provides | IPAP and EPAP
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| During BiPaAP CPAP is active | when IPAP = EPAP
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| IPAP is | Inspiratory positive airway pressure
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| IPAP controls | peak inspiratory pressure during inspiration
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| EPAP is | Expiratory positive airway pressure
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| EPAP controls | end-expiratory pressure
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| EPAP is used as CPAP when | IPAP = EPAP
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| EPAP is used as PEEP when | IPAP > EPAP
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| PEEP is | Positive end-expiratory pressure
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| PEEP is PAP at | end -expiratory phase
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| PEEP is used with | mechanical breaths
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| IPAP is the level of airway pressure | during inpiratory phase only
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| EPAP is the level of airway pressure | during expiratory phase only
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| The degree of ventilation is directly related to the | IPAP level
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| HIGHer IPAP level would result in | Larger tidal volume and minute ventilation
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| The level of IPAP and EPAP can be titrated according to | a patients oxygenation and ventilation needs
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| the two benifits of NPPV are | improvement of PO2 and PCO2
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| CPAP does not include | any mechanical breaths
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| CPAP is the treatment of choice for | obstructive sleep apnea without significant CO2 retention
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| OSA is caused by | severe airflow obstruction during sleep
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| CPAP provides | positive airway pressure during the entire sontaneous breath
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| During CPAP the work of breathing is | entirely assumed by the patient
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| CPAP should be used with care and | close monitoring of the patient as it is not effective in apnea due to neuromuscular causes
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| Sleep apnea is defined as | a temporary pause in breathing that lasts at least 10 seconds during sleep
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| Sleep apnea is caused by | Air Flow obstruction (OSA) or a loss of neurologic breathing effort (central sleep apena), or a combination of these two conditions (mixed sleep apnea)
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| Indications for CPAP | Obstuctive sleep apnes
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| Contraindications for CPAP | Apnea due to neuromuscular causes, progressive hypoventilation, fatigue of respiratory muscles, facial trauma, claustrophobia
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| Apnea index is | average number of apneas in each hour of sleep during a test
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| hypopnea is | reduction in airflow for 10 or more seconds that is at least 50% below an estimated baseline amplitude.
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| hypopnea is usually associated with | an oxygen desaturation or a pulse alteration
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| apnea-hypopnea index is | average number of apnea and hypopnea in each hour of sleep during a test
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| desaturation index is | average number of oxygen desaturations of 4% or more from baseline in each hour of sleep during a test
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| treatments for OSA include | oral applications such as prosthetic mandibular advancement, surgical interventions such as tonsillectomy and uvulopalatopharyngoplasty for upper obstructions, and weight reduction gastric surgery for morbidly obese patients.
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| Risk factors for OSA include | History of snoring and witnessed apneas, obesity, increased neck circumference, hypertension, and family history of OSA
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| OSA major clinical signs and symptoms are | snoring, daytime sleepiness, restless sleep, morning fatigue, and headaches.
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| If untreated OSA can lead to | hypertension, left and right ventricular hypertrophy, sudden cardiovascular death, and increased risk for brain infarction
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| BiPAP has how many pressure levels | 2
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| CPAP has how many pressure levels | one
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| PEEP is defined as | an airway pressure that is above 0 cm H2O at end-expiration
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| Two indications for bilevel PAP are | accute respiratory failure and acute hypercapnic exacerbations of COPD
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| BiPAP differes from CPAP in that | BiPAP has two pressure levels, whereas CPAP has only one
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| In BiPAP has an IPAP setting that provides | mechanical breaths
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| BiPAP has an EPAP setting that | functions as positive end expiratory pressure
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| The most common criteria for the determination of acute respiratory failure | blood gas results that typically show partially compensated respiratory acidosis with moderate hypoxemia
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| Patients that are not candidates for NPPV are | unable to use or tolerate nasal or facial mask
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| Indications for NPPV | reduction of respiratory workoad in obesity, acute respiratory failure, acute hypercapnic exacerbations of COPD
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| Contraindications for NPPV | Apnea, unalbe to handle secretions, facial trauma, claustrophobia
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| Interfaces for NPPV | Nasal mask, facial mask, nasal pillows
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| Nasal mask is | a mask that covers only the nose
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| A minor leak in a nasal mask is | considered acceptable.
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| When a leak in a nasal mask is significant | a facial mask should be considered
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| A Facial mask is | a mask that covers the nose and mouth
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| Potential problems when using a facial mask include | Regurgitation and aspiration
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| Advantagles of using a Nasal mask | Comfort, patient compliance
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| Disadvantages of using a nasal mask | gas leaks, nasal dryness or drainage
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| advantage of using the facial mask | good seal
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| disadvantages of using a facial mask | claustrophobia, patient noncompliance, regurgitation and aspiration, asphyxiation in power or gas outage, alarm and monitor may be necessary
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| IPAP is an | airway pressure above 0 cm H2O during inspiration
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| EPAP is an | airway pressure that is above 0 cmH2O at end expiration
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| The initial CPAP setting is started at | 4 cmH2O and titrated to a desired endpoint
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| What is RAMP | the starting pressure is set low and gradually increases over time (up to 45 minutes) until the desired pressure is reached.
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| RAMP is ideal for | patients who may have trouble tolerating a sudden onset of high pressure
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| What is C-FLEX | a method of delivering aCPAP for the treatment of OSA
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| The initial BiPAP pressures are started at | 8 cm H2O (inspiratory, and 4 cm H2O expiratory pressure and titrated to a desired endpoint.
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| What is Bi-Flex | A method of delvering bilevel PAP in which the airflow during inhalation and exhalation is "softened" this makes breathing more natural and comfortable for the patient
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| titration endpoints of IPAP and EPAP during bilevel PAP do not include | PvO2
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| NPPV can not provide | positive end expiratory pressure (PEEP)
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