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Noninvasive Ventilat

Bipap Vision

QuestionAnswer
What is CPAP? A Constant pressure applied to the spontaneously breathing patient.
CPAP is applied via a mask-type device
CPAP Does not provide volume change or support in patient's minute ventilation
What are the indications for CPAP? Treats OSA Improves Oxygenation
What does NPPV do? Pressure is applied intermittently with inspiration having a higher pressure than expiration.
NPPV is applied via a mask type device
What are the indications of NPPV? Acute respiratory failure chronic respiratory failure
NPPV provides greater flexibility in initiation and removing mechanical ventilation
NPPV permits normal eating, drinking and communication with the patient
NPPV preserves airway defense, speech and swallowing mechanisms
NPPV avoids trauma associated with intubation, the complications associated with artificial airways
NPPV reduces the risk of VAP
NPPV reduces the risk of ventilator induced lung injury associated with high ventilating pressures
NPPV reduces muscle work and helps to avoid respiratoyr muscle fatigue that may lead to acute respiratory failure.
NPPV provides ventilator assistance with greater comfort, convenience, and less cost than invasive ventilation
NPPV reduces requirements of heavy sedation
NPPV reduces the need for invasive monitoring
What are some contraindications of NIV? Respiratory arrest(apnea) or the need for immediate intubation, Unable to protect the airway, excessive secretions, hemodynamic instability, agitated and confused patients, parodoxical breathing, uper airway obstruction.
What are some other contraindications of NIV? Facial deformities or conditions that prevents mask fit,untreated pneumothorax, uncooperative of unmotivated patients, brain injury with unstable resp. drive, major organ damage (sever hemorrhaging), recent gi surgery, irreversibility of disorder.
What are devices that can be used to provide NIV? Nasal Masks Full Face Masks Nasal Pillows Nasal Cushions Total face mask
When fitting the nasal mask you should choose the smallest mask without obstructing the nostrils.
Where are anatomic leaks with the nasal mask? sides of nose bridge of nose above the lip
For the nasal mask the top of the mask is placed just above the junction of the nasal bone and the cartilage
The nasal mask should not be pinching the nose at the side
The lower part of the nasal mask should fit just above the upper lip
A common error in fitting the nasal mask is choosing a mask that is too large
What attaches to the end of the mask and rests on the forehead and helps reduce pressure on the bridge of the nose? Foam bridges
What are the advantages of nasal masks? Less risk of aspiration Enhanced secretion clearance less claustrophobia easier speech less dead space
What are disadvantages of the nasal mask? Mouth Leak Less Effectiveness with nasal obstruction Nasal irritation and rhinorrhea mouth dryness
Full face masks are most often successful in the critically ill population
The pressure pick off port allows a pressure manometer to measure pressure.
The ball and socket clip (escape clips) allow for easy mask removal
A full face mask surrounds the nose and mouth and rests below the lower lip.
What are the landmarks for a full mask? Below the lower lip with mouth open. Corners of the mouth. Just below the junction of nasal bone and cartilage.
Full face masks should fit even if the patients mouth is slightly open
You should be sure the mask fits well and does not leak excessively particularly not in the eyes.
Full face masks are most effective for dyspneic patients
What are the disadvantages of a full face mask? increased deadspace difficulty in maintaining seal increased risk of pressure sores claustrophobia increased aspiration risk difficulty with speech inability to eat with mask on difficulty with secretion clearance possible asphyxiation with vent
Nasal pillows or nasal cushions are suitable for patients with claustrophobia skin sensitives need for visability
How do you fit a nasal pillow or nasal cushion? plastic size gauge is inserted in each nostril.
Sometimes leaks are caused by the mask not being correctly seated on the face
Some leaks may be caused by excessive tension of the head straps
headgear tension should allow 1-2 fingers between the head straps and face
In patients withou a full set of teeth using a full face or total face mask can help minimize leaks
Vented masks require a vent for exhalation and use only one corrugated tube to connect to the ventilator.
Nonvented masks have both an inspiratory and expiratory line
In a nonvented mask exhaled volumes, flows and pressures can be monitored.
What are complications associated with NIV? Hemodynamic instability risk of aspiration claustrophobia gastric insufflation/distention Use of NG tubes eye irritation poor sleep quality nasal or oral dryness/congestion sinus or ear pain skin problems
The battery only works alarms for 2 minutes and does not support operation of the machen
For the vented system use a filter
The BIPAP Vision can be used invasively unlike others
Leak compensation intentional (vents) unintentional (patients)
The check vent alarm is the yellow eye
The vent inop is the red wrench and can continue to use but will eventually shut down.
The alarm pannel has 8 hard keys 10 soft keys and 1 knob
The self test takes 15-30 seconds when powered on
The exhalation port test checks for intentional leak
It is set in %
The fio2 is +- 10%
The patient leak is unintentional leak
% triggered is the number triggered compared to total triggere
% trigger is active in S/T mode an calculates over 30 minutes time
The typical ipap setting is 8-12 cmh20 It can be adjusted to change VT
The typical EPAP setting is usually started out at 4 and can be increased to improve oxygenation
The desired fi02 is set
The Learn base flow usually learns automatically
It must be performed if 02 is added at mask or a neb is given (any time extra flow is introduced) takes 2 minutes and will not hurt function of the unit
The set rate or back up rate must be set
Rise time determines how fast the vent rises from baseline pressure to target pressure
The high and low pressure alarm must be set +/- 5 if S/T mode is ued
The low pressure delay allows time for EPAP to IPAP usually set at 10 seconds
The low minute ventilation is usually set at 10-20% below patients baseline
The high and low rate alarm must be set
Apnea alarm will alarm if it does not recognize a spontaneous breath
The air leak should be 7-25 L/M for a good fit
The air leak that is 0-6L/M indicates a mask that is too tight
If the air leak is 26-60 L/Minute The mask must be adjusted and monitored
The display flashes with a flow variation of greater than 15 L/Min and has an accuracy of +/- 10%. It allows titration of pressure support and indicates changes in patient status.
The tidal volume/minute ventilation is a running average of the last 6 breaths
TI/Ttot is inspiratory time to total cycle time
The Ti/Ttot helps to evaluate respiratory muscle endurance
if the Ti/Tot is less than 30 it indicates improvement and (IPAP can be decreased)
If the Ti/Ttot is greater than 40% indicates fatigue (increase IPAP)
The normal value for Ti/Ttot is 30-40%
% patient triggered breaths is calculated over a 30 minute period and is updated every minute. It is active only in S/T mode It assesses dependence on the vent Determines readiness to wean.
Created by: kparkerlehman