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S2 Mechanical Vent 1

Chapter 7 Noninvasive Positive Pressure Ventilation

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