Noninvasive ventilation: Difference between revisions
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#Facial, esophageal, or gastric surgery | #Facial, esophageal, or gastric surgery | ||
#Poor mask fit | #Poor mask fit | ||
==Procedure== | |||
#Prepare intubation equipment in case of BPAP/CPAP failure. | |||
#Position the patient in a 30-90° upright position. | |||
#Apply the mask. | |||
##Select the appropriately-sized mask. | |||
##Secure it in place by fastening the Velcro straps. | |||
##Note: Some experts recommend allowing the patient to get used to the mask first, PRIOR TO starting the positive airway pressures. | |||
#Prepare the patient. | |||
##Patients will often require frequent coaching throughout this process. | |||
##In moderately anxious patients, consider a benzodiazepine or Ketamine to assist with patient-ventilator synchrony. | |||
#Adjust the settings. | |||
##For BPAP, begin with an IPAP of 8-10 cm H2O and an EPAP of 2-4 cm H2O. | |||
##Gradually titrate upward IPAP and EPAP 1-2 cm every 5-15 minutes with a goal IPAP 10-16 cm H2O and EPAP of 8-10 cm H2O depending upon patient response. | |||
#Continue close monitoring. | |||
##A doctor, nurse, or respiratory therapist should be with the patient at all times during BPAP/CPAP use. | |||
==Settings== | ==Settings== |
Revision as of 06:03, 6 June 2014
Background
Mechanism of Action
- Augments inspiratory/expiratory pressures throughout a spontaneous respiratory cycle.
- Recruits compressed alveoli to reduce atelectasis.
- Prevents small airway collapse during inspiration.
- Counteracts intrinsic PEEP (Positive End Expiratory Pressure).
- Decreased both preload and afterload in heart failure exacerbations.
- Improves lung compliance and V/Q matching.
- Decreases the work of breathing.
CPAP vs. BPAP
- CPAP = PEEP = EPAP
- BPAP = PEEP + (pressure support = IPAP)
- Note: BiPAP is a brand name of one of the BPAP machines. Both names are often used interchangeably.
Indications
- CHF
- COPD
- Asthma
- OSA
- Pulmonary edema
- Pneumonia
Contraindications
- Obtunded patients
- Uncooperative patients
- Vomiting or inability to protect the airway (aspiration risk)
- Facial trauma or burns
- Facial, esophageal, or gastric surgery
- Poor mask fit
Procedure
- Prepare intubation equipment in case of BPAP/CPAP failure.
- Position the patient in a 30-90° upright position.
- Apply the mask.
- Select the appropriately-sized mask.
- Secure it in place by fastening the Velcro straps.
- Note: Some experts recommend allowing the patient to get used to the mask first, PRIOR TO starting the positive airway pressures.
- Prepare the patient.
- Patients will often require frequent coaching throughout this process.
- In moderately anxious patients, consider a benzodiazepine or Ketamine to assist with patient-ventilator synchrony.
- Adjust the settings.
- For BPAP, begin with an IPAP of 8-10 cm H2O and an EPAP of 2-4 cm H2O.
- Gradually titrate upward IPAP and EPAP 1-2 cm every 5-15 minutes with a goal IPAP 10-16 cm H2O and EPAP of 8-10 cm H2O depending upon patient response.
- Continue close monitoring.
- A doctor, nurse, or respiratory therapist should be with the patient at all times during BPAP/CPAP use.
Settings
- Failure of oxygenation
- Pulmonary Edema, PNA
- Start PEEP 5 (up to 15)
- Recruits alveoli
- Improves V/Q mismatch
- Decreases preload/afterload
- Failure of ventilation
- Asthma, COPD
- When tire out unable to move air
- Need inspiratory pressure support
- Start pressure support 5 (up to 15)
- Consider PEEP 2-3 to overcome the mask
- Asthma, COPD
See Also
Source
EMcrit Podcast 19