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Resp. 2.8

BIPAP pp

QuestionAnswer
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
Created by: TnJFarrington12