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S2 Mechanical Vent 1
Chapter 7 Noninvasive Positive Pressure Ventilation
| Question | Answer |
|---|---|
| noninvasive positive pressure ventilation provides | assisted ventilation without an artificial airway |
| NPPV may be used to assist patients with | obstructive sleep apnea and acute ventilatory failure |
| NPPV provides ventilation via | the patients nose or mouth without an artificial airway |
| NPPV is | Noninvasive positive pressure ventilation |
| NPPV is ventilation without | an artificial airway |
| NPPV may be used as | CPAP or bilevel PAP |
| CPAP is | Continuous positive airway pressure |
| CPAP uses | positive airway pressure during spontaneous breaths |
| CPAP does not use | mechanical breaths |
| CPAP is active | when IPAP = EPAP |
| Bilevel PAP is | Bilevel positive airway pressure also known as BiPAP |
| BiPAP provides | IPAP and EPAP |
| During BiPaAP CPAP is active | when IPAP = EPAP |
| IPAP is | Inspiratory positive airway pressure |
| IPAP controls | peak inspiratory pressure during inspiration |
| EPAP is | Expiratory positive airway pressure |
| EPAP controls | end-expiratory pressure |
| EPAP is used as CPAP when | IPAP = EPAP |
| EPAP is used as PEEP when | IPAP > EPAP |
| PEEP is | Positive end-expiratory pressure |
| PEEP is PAP at | end -expiratory phase |
| PEEP is used with | mechanical breaths |
| IPAP is the level of airway pressure | during inpiratory phase only |
| EPAP is the level of airway pressure | during expiratory phase only |
| The degree of ventilation is directly related to the | IPAP level |
| HIGHer IPAP level would result in | Larger tidal volume and minute ventilation |
| The level of IPAP and EPAP can be titrated according to | a patients oxygenation and ventilation needs |
| the two benifits of NPPV are | improvement of PO2 and PCO2 |
| CPAP does not include | any mechanical breaths |
| CPAP is the treatment of choice for | obstructive sleep apnea without significant CO2 retention |
| OSA is caused by | severe airflow obstruction during sleep |
| CPAP provides | positive airway pressure during the entire sontaneous breath |
| During CPAP the work of breathing is | entirely assumed by the patient |
| CPAP should be used with care and | close monitoring of the patient as it is not effective in apnea due to neuromuscular causes |
| Sleep apnea is defined as | a temporary pause in breathing that lasts at least 10 seconds during sleep |
| 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) |
| Indications for CPAP | Obstuctive sleep apnes |
| Contraindications for CPAP | Apnea due to neuromuscular causes, progressive hypoventilation, fatigue of respiratory muscles, facial trauma, claustrophobia |
| Apnea index is | average number of apneas in each hour of sleep during a test |
| hypopnea is | reduction in airflow for 10 or more seconds that is at least 50% below an estimated baseline amplitude. |
| hypopnea is usually associated with | an oxygen desaturation or a pulse alteration |
| apnea-hypopnea index is | average number of apnea and hypopnea in each hour of sleep during a test |
| desaturation index is | average number of oxygen desaturations of 4% or more from baseline in each hour of sleep during a test |
| 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. |
| Risk factors for OSA include | History of snoring and witnessed apneas, obesity, increased neck circumference, hypertension, and family history of OSA |
| OSA major clinical signs and symptoms are | snoring, daytime sleepiness, restless sleep, morning fatigue, and headaches. |
| If untreated OSA can lead to | hypertension, left and right ventricular hypertrophy, sudden cardiovascular death, and increased risk for brain infarction |
| BiPAP has how many pressure levels | 2 |
| CPAP has how many pressure levels | one |
| PEEP is defined as | an airway pressure that is above 0 cm H2O at end-expiration |
| Two indications for bilevel PAP are | accute respiratory failure and acute hypercapnic exacerbations of COPD |
| BiPAP differes from CPAP in that | BiPAP has two pressure levels, whereas CPAP has only one |
| In BiPAP has an IPAP setting that provides | mechanical breaths |
| BiPAP has an EPAP setting that | functions as positive end expiratory pressure |
| The most common criteria for the determination of acute respiratory failure | blood gas results that typically show partially compensated respiratory acidosis with moderate hypoxemia |
| Patients that are not candidates for NPPV are | unable to use or tolerate nasal or facial mask |
| Indications for NPPV | reduction of respiratory workoad in obesity, acute respiratory failure, acute hypercapnic exacerbations of COPD |
| Contraindications for NPPV | Apnea, unalbe to handle secretions, facial trauma, claustrophobia |
| Interfaces for NPPV | Nasal mask, facial mask, nasal pillows |
| Nasal mask is | a mask that covers only the nose |
| A minor leak in a nasal mask is | considered acceptable. |
| When a leak in a nasal mask is significant | a facial mask should be considered |
| A Facial mask is | a mask that covers the nose and mouth |
| Potential problems when using a facial mask include | Regurgitation and aspiration |
| Advantagles of using a Nasal mask | Comfort, patient compliance |
| Disadvantages of using a nasal mask | gas leaks, nasal dryness or drainage |
| advantage of using the facial mask | good seal |
| disadvantages of using a facial mask | claustrophobia, patient noncompliance, regurgitation and aspiration, asphyxiation in power or gas outage, alarm and monitor may be necessary |
| IPAP is an | airway pressure above 0 cm H2O during inspiration |
| EPAP is an | airway pressure that is above 0 cmH2O at end expiration |
| The initial CPAP setting is started at | 4 cmH2O and titrated to a desired endpoint |
| What is RAMP | the starting pressure is set low and gradually increases over time (up to 45 minutes) until the desired pressure is reached. |
| RAMP is ideal for | patients who may have trouble tolerating a sudden onset of high pressure |
| What is C-FLEX | a method of delivering aCPAP for the treatment of OSA |
| The initial BiPAP pressures are started at | 8 cm H2O (inspiratory, and 4 cm H2O expiratory pressure and titrated to a desired endpoint. |
| 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 |
| titration endpoints of IPAP and EPAP during bilevel PAP do not include | PvO2 |
| NPPV can not provide | positive end expiratory pressure (PEEP) |
Created by:
murphyismyname
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