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Egan Ch 45


Define Hypoxemic Respiratory Failure. the inability to maintain norm oxygen in art blood: P/F ratio<300; PaO2<60mmHg w/supp O2
Pt receives NPPV for hypoxemic resp failure, w/o improv how long should wait to intubate? No more than 1-2 hours. If pt declines w/in first 30 mins, don't wait.
What 3 conditions assoc w/hypoxemic resp fail qualify NPPV as 1st Line therapy? 1)immunocomprmised 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 polio;chest wall deform.;spinal injuries;severe kyphoscholeiosis;NMD
What are 3 benefits gained by NPPV in Restrictive Thoracic Diseases 1)Improved lung compliance,volume/FRC,dead space 2)Rest muscles of insp 3)lower PaCO2
Name 6 predictors of successful NPPV use in the acute care setting 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 Ventilator;Critical Care Ventilator;Portable Volume Ventilator
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 mask,full face mask,mouth pc,total face mask,nasal pillows,helmet
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;abnor anat;uncooperativ
Name the 4 ways NIV can be provided Negative Pressure Ventilator;Positive Pressure Ventilator;Rocking Bed; Pneumobelt
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 same thing) 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 aka: NPPV, NIPPV, NIV
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)
what 5 nocturnal hypoventilation signs must be seen for NPPV therapy to be considered w/RTD? 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 increased.. . ...Tidal Volume decreases, PaO2 increases, and FRC increases
When rate control is increased... ...Minute Volume increases, PaCO2 decreases
Created by: wickelbie