Modes of Respiratory Support
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Does Pressure Support ventilation support spontaneous respiration?
Yes, it supports spontaneous respiration
How does Pressure Support work (inspiratory and expiratory phases)
During inspiratory phase, it supports respirations with a set pressure.
A second pressure, PEEP, is the amount of presure that is delivered during exhalation and in between respirations.
What is a problem with Pressure Support?
There is no set rate and, thus, there is no protection from apnea
When is Pressure Support used?
Usually, it is used in the weaning phase of ventilation, where it may be useful to promote respiratory respiratory muscle training and to compensate for the high resistance of the endotracheal tube
Things to watch with Pressure Support are...
rate and tidal volume
What happens if the pressure support parameter is set too high?
the patient's respiratory rate may decline, as a lower respiratory rate with larger tidal volumes will maintain minute ventilation
What happen if the pressure support ventilation is set too low?
the respiratory rate will increase to achieve adequate minute ventilation
What happens if the patient is not able to increase his/her minute ventilation in cases of low pressure support ventilation settings... (what are they at risk for developing)
hypoventilation and atelectasis
What does Volume Support do/when is it used?
It may be useful to promote respiratory muscle retraining and compensation for the high resistance of the endotracheal tube during spontaneous respiration.
Used during weaning phase of ventilation
What values are set in Volume Support?
- expected minute ventilation
- tidal volume
- lowest possible pressure (used to deliver the set tidal volume)
What monitoring is required in Volume Support?
peak pressure and respiratory rate
What is the risk with Volume Support? (What isn't protected against?)
apnea - patients must have adequate ventilatory drive
What kind of respiratory support does Noninvasive Ventilation (NIV) give?
positive pressure via a full face mask, nasal mask, nasal pillows or helmet
Contraindications to NIV
- conditions that:
- impair airway protective reflexes
- invoke reduced respiratory drive
- frank respiratory failure
Challenges to NIV
finding the appropriate "fit" for pediatric patients
Special concerns with NIV
- When appropriate fit is found, pressure points of skin contact with the NIV device must be monitored for SKIN BREAKDOWN.
- requires a calm and cooperative patient
- eye irritation/dryness (use eye lubricants & a proper mask fit)
- abdominal distention (if this is a concern, place a NG tube to decompress the stomach)
Why use NIV vs invasive ventilation? (6)
- elimination of the risk of upper airway trauma
- elimination of the risk of ventilator-associated pneumonia (VAP)
- reduced or elimination requirement for anxiolysis and analgesia
- ongoing use and exercise of underlying respiratory muscles
- reduced cost
- less complex technology
What kind of support does CPAP provide?
one set level of positive pressure throughout the respiratory cycle
What does CPAP help prevent?
- alveolar atelectasis
- increase functional residual capacity (FRC)
- may provide distending pressure to overcome upper airway obstruction
What does CPAP not prevent?
What are things to monitory when a patient is on CPAP to determine the success of the CPAP trial?
- work of breathing
- O2 sat
- carbon dioxide levels
What are typical levels for CPAP?
What is different about BiPAP vs CPAP?
- it provides 2 levels of pressure during the respiratory cycle:
- one during inspiratory phase - inspiratory positive airway pressure (IPAP)
- another during expiratory phase - expiratory positive airway pressure (EPAP)
When does BiPAP deliver the preset IPAP?
when it senses the patient's inspiratory effort
When does BiPAP deliver the preset EPAP?
When it senses the end of inspiration
Which is always greater IPAP or EPAP?
What is ensured if the spontaneous timed mode is used with BiPAP?
- the patient is receiving some larger breaths with IPAP
- there is a backup rate ---> NO APNEA
What happens if the patient is breathing faster than the preset backup rate on BiPAP?
the machine will NOT deliver additional breaths to the patient (the minimum rate preset on the device is met, so no additional breaths are delivered)
When is BiPAP is useful?
both acute and chronically ill children - both intrinsic lung disease and upper airway obstruction
Acute indications for NIV
- Upper airway obstruction
- Pulmonary edema
- End-of-life palliation
Chronic indications for NIV
- chronic lung disease
- cystic fibrosis
- neuromuscular disease
- obstructive sleep apnea syndrome
In high-frequency oscillatory ventilation (HFOV), where is happening?
gas is forced into the lung during inspiration
How is HFOV different than conventional ventilation?
it actively removes air during expiration
Are tidal volumes low or high with HFOV?
What are tidal volumes dependent on with HFOV?
- endotracheal tube size
Ventilation in HFOV is a function of...
- inspiratory-expiratory (I:E) ratio
In HFOV, do lower frequencies remove more/less CO2?
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