Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
32 Cards in this Set
- Front
- Back
|
NONINVASIVE VENTILATION Negative Pressure Ventilation Definition
|
The application of positive pressure via the upper respiratory tract for the purpose of augmenting alveolar ventilation
|
|
|
Goals of NPPV
Acute Care Setting: |
Avoid intubation
Relieve symptoms of dyspnea Enhance gas exchange Improve patient-ventilator synchrony Maximize patient comfort Decrease length of stay |
|
|
Indications for NPPV:
Acute Care |
COPD
Hypercapnic respiratory failure (during exacerbation) Early intervention Trend the PaCO2 & pH |
|
|
Acute Cardiogenic Pulmonary Edema
|
Historically – CPAP
NPPV with IPAP / EPAP shown to be beneficial |
|
|
Indications for NPPV:
Acute Care |
Hypoxemic Respiratory Failure
P/F ratio < 200 Increase PAO2 to increase PaO2 (increasing FIO2 à NRB à CPAP) Positive pressure at end exhalation allows for continuous diffusion of O2 |
|
|
Other Indications
|
DNR situations
Weaning from mechanical ventilation Avoid re-intubation |
|
|
Indications for NPPV: Chronic Care
|
Restrictive Thoracic Disease
NPPV rests the respiratory muscles Decreases PaCO2 Improves lung compliance Long Term Care of COPD Used nocturnally improves sleep quality Relieves nocturnal hypoventilation Improves daytime gas exchange Nocturnal Hypoventilation Central sleep apnea, OSA Obesity hypoventilation (Pickwickian) |
|
|
Patient Selection:
|
Acute Care Establish the need for ventilatory assistance
2 or more signs & symptoms present -use of accessory muscles -paradoxical breathing -RR > 25 -dsypnea -PaCO2 > 45mmhg & pH < 7.35 -P/F ratio < 200 |
|
|
Patients are EXCLUDED if any of the following are present:
|
apnea
-hemodynamic or cardiac instability -uncooperative behavior -facial burns, facial trauma -high risk of aspiration -copious secretions -anatomic abnormalities that interfere with gas delivery |
|
|
Chronic Care Nocturnal hypoventilation due to disorders other than restrictive lung disease and COPD
|
-sleep apnea
Chronic hypoventilation (COPD) with poor quality sleep -PaCO2 > 55 or -PaCO2 50 -54 -SpO2 < 89% after 2 minutes of at least 28% -recurrent hospitalization (2 or more visits in 12mths) |
|
|
Chronic Care
Exclusion Criteria |
-unsupportive family
-lack of financial resources -ventilator assistance during the day -copious secretions -uncooperative behavior -risk of aspiration |
|
|
Patient Interfaces
|
Masks
-nasal mask -full face mask -selection based on patient comfort & fit Sizing -mask must seal Nasal Prongs/Nasal Pillows -soft cushions that fit into nares Mouthpieces Head gear & Chin straps |
|
|
Ventilators: Positive Pressure Generators Noninvasive Ventilators
|
-electrically powered
-blower driven -microprocessor controlled -single circuit design -flow & pressure measurements are used by microprocessor to control gas delivery to patient -alarms for disconnect, loss of power and battery failure -O2 is bled into circuit (FIO2 will vary) |
|
|
Noninvasive Modes
|
CPAP
-BiPAP IPAP & EPAP -spontaneous patient triggered inspiration -pressure limited inspiration -time cycled & timed triggered (bi-level ventilators) |
|
|
Generators Critical Care Ventilators
|
pneumatically powered
-microprocessor controlled -dual limb circuit -internal blenders allow precise FIO2 -monitors & alarms -pressure & volume modes that can be combined with PEEP |
|
|
Home Care / Portable Ventilators
|
electrically powered
-microprocessor controlled -single limb -used for patients who need continued ventilatory support or high ventilatory pressures |
|
|
Humidification
|
heated humidity may be required
-added feature -relieves nasal discomfort -patient complaints: nasal drainage dryness sneezing |
|
|
Set up equipment
|
Set up equipment in an appropriate location based on the severity of the patient’s condition
Select the type of ventilation and appropriate interface Patient should be seated at a 30o angle for sizing Connect the ventilator to interface Turn on the ventilator Set initial settings |
|
|
Initiation of Noninvasive Ventilator (NPPV):
|
-CPAP: 5 – 12 cmH20
-BiPAP: S/T mode with IPAP of 8 – 12 cmH20, EPAP of 3 – 5 cmH20, rate of 8 Critical Care Ventilator: -PSV: 5 – 8 cmH20, PEEP 0 – 5 cmH20 Flow triggering 2 – 5 lpm -Assist control mode with a VT of 10ml/kg, flow of 60 lpm, rate of 10, PEEP of 0 – 5 cmH20, flow triggering 2 – 5 lpm |
|
|
Initiation of NPPV
|
Place headgear and mask on patient
-homecare: teach patient how to apply -hospital: the therapist will take responsibility for setup Adjust FIO2 or bleed-in O2 to keep SpO2 > 90% Once patient adjusts to initial settings increase pressure or VT to prescribed settings Check for air leaks; adjust straps Follow-up assessment |
|
|
NPPV Adjustments
|
42 NPPV Adjustments
Settings Adjustments Results |
|
|
Monitoring during NPPV Leaks in patient interface
Accessory muscle use Ventilator synchronization Patient comfort Improvement in vital signs Improvement in gas exchange Improvement in RR, HR, gas exchange within 30 min – 2 hrs Worsening condition after 30 min indicates a need for intubation |
Leaks in patient interface
Accessory muscle use Ventilator synchronization Patient comfort Improvement in vital signs Improvement in gas exchange Improvement in RR, HR, gas exchange within 30 min – 2 hrs Worsening condition after 30 min indicates a need for intubation |
|
|
Weaning from NPPVAs
|
from NPPVAs the disease process or acute situation resolves settings are lowered and amount of time on
NPPV is decreased Decrease in IPAP Decrease in EPAP Maintain gas exchange Monitor patient |
|
|
Complications Mask Related:
|
Discomfort
Claustrophobia Redness Inflammation Ulceration Skin breakdown Corrective Action: Proper fit, adjust Pillows or prongs Strap tension or may need wound care dressing Remove mask for 15 min every 4 to 6 hours |
|
|
Complications Air Pressure:
|
Nasal congestion
Dryness Eye irritation Gastric Insufflation: aerophagia |
|
|
Corrective Action:
|
Add humidity to
ventilator (Results from air leak) – fit mask Use the lowest possible pressure |
|
|
Complications Mask Related:
|
Discomfort
Claustrophobia Redness Inflammation Ulceration Skin breakdown Use the lowest possible pressure |
|
|
Corrective Action:
Mask related |
Proper fit, adjust
Pillows or prongs Strap tension or may need wound care dressing Remove mask for 15 min every 4 to 6 hours |
|
|
Complications Air Pressure:
|
Nasal congestion
Dryness Eye irritation Gastric Insufflation: aerophagia |
|
|
Corrective Action:
Air pressure related |
Add humidity to
ventilator (Results from air leak) – fit mask |
|
|
Other Indications
|
DNR situations
Weaning from mechanical ventilation Avoid re-intubation |
|
|
Indications for NPPV: Chronic Care Restrictive Thoracic Disease
|
NPPV rests the respiratory muscles
Decreases PaCO2 Improves lung compliance Long Term Care of COPD Used nocturnally improves sleep quality Relieves nocturnal hypoventilation Improves daytime gas exchange Nocturnal Hypoventilation Central sleep apnea, OSA Obesity hypoventilation (Pickwickian) |
