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When compared to PEEP what will be lower on CPAP?
MAP
What is CPAP is for?
1. Treatment of obstructive sleep apnea
2. Prevents oropharyngeal tissue collapse
3. Decreases desaturation events, allowing better REM sleep
4. Reverses the effects of hypercarbia
When weaning a patient off CPAP how man increments is the patients reduced every 6-8 hours?
3-5cm
When weaning a patient off PEEP/CPAP decrease FIO2 to 60% while maintaining a PaO2 of what?
60 or higher
When weaning a patient off PEEP/CPAP what should the patient be check for?
1. Hemodynamic stability
2. Sepsis
What are the home uses for BiPAP/CPAP?
1. Obstructive sleep apnea
2. Very obese patients
What is used in acute care in attempt to avoid endotracheal intubation and conventional CMV?
BiPAP/CPAP
What are the modes used in delivering BiPAP?
1. Spontaneous
2. Spontaneous/Time
3. Time/control
Which BiPAP mode is used in patients with long periods of apnea and apneic spells?
Spontaneous/Time
Which BiPAP mode is used in patients with high WOB and high minute volume?
Time/Control
What are the patient interfaces of BiPAP?
1. Nasal or oral face mask
2. Nasal pillows
3. Prongs
What are the two levels of CPAP delivered by BIPAP to a spontaneously breathing patient?
IPAP and EPAP
Which CPAP level delivered on BiPAP is the continous flow of gas past a patient airway.
IPAP
Which BiPAP level is the same as PIP?
IPAP
What is the highest setting for IPAP?
20 cm
Which BiPAP level is the same as CPAP/PEEP?
EPAP
Which BiPAP level increases FRC and increases PaO2?
EPAP
On BiPAP _______ must always be larger than _______
IPAP must be always be larger than EPAP
Which BiPAP setting is used to address and correct problems with ventilation (PaCO2)?
IPAP
Which BiPAP setting is used to correct Oxygenation problems?
EPAP
How do you get the amount of pressure support level which is a driving pressure maintaining the delivered tidal volume to the patient.
IPAP-EPAP
What is the first line therapy for management of acute exacerbations of COPD?
BiPAP
Prematurely extubated patients should be placed on what mode of mechanical ventilation to avoid intubation?
BiPAP
BiPAP is used in DNR patients for what?
As a comfort measure
What type of mechanical ventilation is used for DNI patients?
BiPAP
Acute Exacerbation of CHF and pulmonary edema may be treated with what NPPV?
BIPAP/CPAP
For type II respiratory failure what is the minimum pH for a patient to be placed on BiPAP?
7.35
A PaCO2 of what is needed to place a patient with type II respiratory failure on BiPAP?
50-55 torr
PaO2 of what is an indication to place a patient on a BiPAP?
Less than 60 mmHg
What kind of neuromuscular diseases are an indication for BiPAP?
spinal cord injuries and kyphoscoliosis
How do you determine if a patients has auto-PEEP?
1. Flow/Time waveform
2. Volume/Time waveform
3. End-expiratory hold/pause
4. Flow/Volume loop
Adding Peep greater than auto-PEEP is an effective way to treat auto-PEEP in patients with what?
Dynamic airway obstruction
What is the most definitive way to identify auto-PEEP on a ventilated patient?
End-expiratory hold/pause
What ventilator modes can help correct auto-PEEP? Why do these modes help correct auto-PEEP?
Switch the patient to IMV/SIMV mode, to establish better patient ventilator synchrony
What are the contraindications of BiPAP?
1. Apnea
2. Inability to tolerate nasal or oral mask
3. Poor mask fit
4. Severe hypoxemia
5. Severe acidosis
6. Hypotension
7. Upper airway obstruction
8. Patients prone to aspirations
9. Status asthmaticus
What is the most effective way to correct auto-PEEP?
Decreases the minute volume such as decreasing rate or tidal volume
True or false: Use sedation for patients with anxiety issues to correct auto-PEEP
True
Why is it important to set a low pressure alarm on CPAP and NPPV?
Will alert an air leak and a disconnect from the machine
What are the advantages of BiPAP?
1. Avoidance of intubation and associated complications
2. Preservations of natural airway defenses
3. Patient comfort
4. Maintenance of speech and swallowing
5. Less need for sedation
6. Intermittent use
In volume targeted mode if left uncorrected auto-PEEP can cause what?
Pressures in the airways to increase exposing the patient to pulmonary Barotrauma/volutrauma, VILI, and pneunothorax
What are the advantages of BiPAP?
1. Avoidance of intubation and associated complications
2. Preservation of natural airway defenses
3. Patient comfort
4. Maintenance of speech and swallowing
5. Less need for sedation
6. Intermittent use
Auto-PEEP can do what to ICP? ( not talking about insane clown posse by the way)
Increase intracranial pressure
Adding a expiratory retard is a method of correcting what?
Auto-PEEP
How can auto-PEEP effect venous return, cardiac output and blood pressure?
Can impede venous return and cause significant drop in cardiac output and blood pressure
What are the disadvantages of BiPAP?
1. Patient cooperation needed
2. Limited access to airway and suctioning
3. Mask discomfort
4. Facial ulcers, eye irritation, rhinitis, dry nose
5. Air leak
6. Claustrophobia
7. Tissue necrosis
8. BiPAP limited to 20-30cm
How do you correct auto-PEEP with changes to a patients I:E ratio? How does this change affect the I:E ratio?
Increase the peak inspiratory flow rate which decreases the I-time, increases the Etime and decreases the I:E ratio allowing more time for exhalation
If auto-PEEP is caused by increased airway resistance what can be effective in correcting it?
Bronchodilation and frequent suctioning
What type of patients are prone to auto-PEEP?
1. COPD patients with dynamic hyperinflation and small airway obstruction
2. High expiratory lung resistance and high lung compliance
3. Assist control and control mode ventilator patients
4. patients that are mechanically ventilated with high frequency, high Vt, and small ETT
5. Patients with longer time constant
6. Ventilated patients with inappropriately set trigger sensitivity and peak Inspiratory flows
7. Pressure control inverse ratio ventilated patients
8. Any factor that increases I-time and I:E ratio and decreases E-Time
What are the synonyms (Yes I can spell it now damnit, don\'t judge me) for auto-PEEP?
Dynamic hyperinflation, inadvertent PEEP, occult PEEP, and intrinsic PEEP
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