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

  1. CHF
  2. COPD
  3. Asthma
  4. OSA
  5. Pulmonary edema
  6. Pneumonia

Contraindications

  1. Obtunded patients
  2. Uncooperative patients
  3. Vomiting or inability to protect the airway (aspiration risk)
  4. Facial trauma or burns
  5. Facial, esophageal, or gastric surgery
  6. Poor mask fit

Procedure

  1. Prepare intubation equipment in case of BPAP/CPAP failure.
  2. Position the patient in a 30-90° upright position.
  3. Apply the mask.
    1. Select the appropriately-sized mask.
    2. Secure it in place by fastening the Velcro straps.
    3. Note: Some experts recommend allowing the patient to get used to the mask first, PRIOR TO starting the positive airway pressures.
  4. Prepare the patient.
    1. Patients will often require frequent coaching throughout this process.
    2. In moderately anxious patients, consider a benzodiazepine or Ketamine to assist with patient-ventilator synchrony.
  5. Adjust the settings.
    1. For BPAP, begin with an IPAP of 8-10 cm H2O and an EPAP of 2-4 cm H2O.
    2. 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.
  6. Continue close monitoring.
    1. A doctor, nurse, or respiratory therapist should be with the patient at all times during BPAP/CPAP use.

Settings

  1. Failure of oxygenation
    1. Pulmonary Edema, PNA
    2. Start PEEP 5 (up to 15)
      1. Recruits alveoli
      2. Improves V/Q mismatch
      3. Decreases preload/afterload
  2. Failure of ventilation
    1. Asthma, COPD
      1. When tire out unable to move air
    2. Need inspiratory pressure support
    3. Start pressure support 5 (up to 15)
    4. Consider PEEP 2-3 to overcome the mask

See Also

Source

EMcrit Podcast 19