BIPAP pp
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| What is BiPAP | non invasive device that augments pt ventilation
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| What are the 2 levels of pressure | IPAP and EPAP
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| On BiPAP which one is larger | larger on insp ex 12/5
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| BiPAP is always | spontaneous
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| IPAP | increase the increments of 2 cmH20.
used if there is a CO2 problem (ventilation)
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| EPAP | increase in increments of 2 cmH20.
Oxygenation problem, similiar to PEEP
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| Spontaneous | pt triggers ALL inspirations which are pressure supported. You set IPAP and EPAP only. Pt determines RR, volume
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| S/T | Pt determines volume, if pt does not breath, cycles to IPAP when time has elapsed.`
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| 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)
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| CPAP mode | pressure is set on continous, pt breaths on it's own, pt is control of RR and volume, set EPAP only
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| indications for BiPAP | resp failure, post surgical, hypoxemia due to hypoventilation, sleep apnea, vent muscle fatigue, upper airway obstruction, post extubation difficulties
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| contraindications for BiPAP | pre existing pneumothorax, hypotension, pre existing bullous lung disease (emphysema), nose bleeding, aspiration, sinusitus
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| side effects of BiPAp | pressure ulcers, claustophobic, eye irratiation
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| What do you adjust IPAP for | ventilation problems
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| What do you adjust EPAP for | oxygenation problems
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| Benefits of BiPAP | can talk, non invasive, infection risk decreased, works in presence of leaks,
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| GOALS of BiPAP | avoid intubation, pt mobility improvement, decrease VAP, improve gas exchange
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| IPAP initial setting | 8-12 cmH20
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| EPAP initial setting | 3-5 cmH20
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| Initial setting for oxygen | match pt's or titrate to obtain acceptable PaO2
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| initial settings for BPM | 2-5 less than pt's spontaneous rate
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| intitial settings for % IPAP | usually 33-50% to deliver 1:2 or 1:1
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| 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)
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| What to do if you have hypoxemia | increase level of EPAP
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| IF unit stops and starts | check power cord, check connection
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| if there is no air flow from unit | check voltage selector switch, possible internal problem
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| unit runs but light not activated | replace light
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| How many sets on BiPAP | 2, CPAP and S/T
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| What do you want to set RR on | 4-40 bpm
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| What do you want to set IPAP on | 4-40 cmH20
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| What do you want to set EPAP on | 4-20 cmH20
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| What does the exhalation port do | directs air. Exhale goes through port so pt doesn't rebreath their CO2
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| What does the exhalation port test do | anaylyzes leak rate of exhalation port.
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| Pt flow triggered breaths are | flow cycled
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| Time triggered breaths are | time cycled according to the set insp time
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| 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
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| What is the whisper swivel | designed to exhaust CO2 from pt's circuit
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| Pt's tidal volume should be | 20% greater than what they are doing
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| Pt with chronic hypercapnia IPAP should | be adjusted to maintain an acceptable pH NOT normalize the PaCO2
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