Card Set Information
CPAP is the maintenance of:
positive pressure throughout the whole respiratory cycle (inspiration and expiration), when breathing spontaneously
indications for CPAP:
Being weened from PEEP to obtain re-opening of atelectasis
Hypoxic following extubation
Hypoxic but not exhausted
Pressure for CPAP:
1 set pressure (cm H2O)
5-20 cm H2O
BIPAP is the maintenance of:
higher set positive pressure during inspiration and a lower set pressure during exhalation
higher pressure- insp
lower pressure- exhale
Benefits of BIPAP:
Maintains patency of airways and alveoli
Improves gas exchange
Improves delivery of bronchodilators
Moves extracellular fluid into vasculature
Reduces work of breathing
indications for BIPAP:
Non-tolerance of CPAP
Respiratory failure--hypercapnea and hypoxemia
Hypoxic following extubation
Pressure for BIPAP:
to improve ventilation:
to improve oxygenation:
: 10-20 cm H2O
: 5-10 cm H2O
to improve ventilation
: IPAP- blow off CO2
to improve oxygenation
when using PAP, what occurs during inspiration:
what occurs in the alveoli?
IPAP forces air into the lungs, therefore, less work is required from the respiratory muscles
this decreases the work of breathing
The alveoli and bronchioles are prevented from collapsing at the end of expiration = less pressure needed to re-expand them.
CI for CPAP/BIPAP:
1. Recurrent pneumothoraces / untreated pneumothorax
2. Severe post-operative pulmonary air leak
3. Central Apnea
5. Any condition where an elevated Intracranial Pressure is undesirable or where reduction in cerebral blood flow is inappropriate
6. Any situation where there is already significant lung over-distension
7. Unstable facial fractures, extensive facial surgery or lacerations and facial burns
8. Laryngeal trauma, recent tracheal anastamosis
9. Recent ear, nose and throat surgery
10. Inability to maintain their own airway
Rhinorrhea (runny nose)
Induced central apnea
Conjuctivitis (eye infection)
Which PAP needs to be higher?
IPAP or EPAP
IPAP needs to be HIGHER than EPAP
what is a good PAP starting ratio?
what do you do if no improvement in O2?
what do you do if no improvement in CO2?
why do you need a good ratio btwn IPAP and EPAP?
a good ratio allows for exhalation
a poor ratio can cause air trapping
want 4 or 5 gradient btwn IPAP and EPAP
indications for mechanical ventilation?
Failure to adequately ventilate
Failure to adequately oxygenate
what are some concerning findings with mechanical ventilation?
Respiratory rate > 35/min or less than 6/min
Inability to maintain arterial O2 saturation > 90% with fractional inspired O2 (Fio2) > 0.60
PaCO2 > 55 mm Hg with pH < 7.25
Vital capacity < 15 ml/kg in adults and 10 ml/kg in children
why is it imp to look at pH when looking at PaCO2?
bc a low PaCO2 could be their norm. The pH tells you whether or not the body is compensating
(good or bad)
delivers pressure regardless of patient's own inspiratory efforts
ASSIST-CONTROLVENTILATION (A/C) OR CONTINUOUS MANDATORY VENTILATION (CMV):
delivers pressure in response to the patient's inspiratory effort, but will initiate the breath if the patient does not do so within a preset amount of time
Pressure Regulated Volume Controlled (PRVC)-
a form of A/C, breaths can be ventilator or patient initiated.
A constant pressure is applied throughout inspiration.
Ventilator adjusts pressure from breath to breath to deliver a set tidal volume
SYNCHRONOUSINTERMITTENT MANDATORY VENTILATION (SIMV):
delivers the preset volume and preset respiratory rate while allowing the patient to breathe spontaneously.
The vent initiates each breath in synchrony with the patient's breaths
POSITIVE-ENDEXPIRATORY PRESSURE (PEEP)
Same as EPAP.
positive pressure that is applied by the ventilator at the end of expiration
PRESSURE SUPPORT VENTILATION (PSV):
preset pressure which augments the patient's spontaneous inspiration effort and decreases the work of breathing
(makes sure the pt reaches a certain pressure before exhaling)
HIGHFREQUENCY VENTILATION (HFV):
delivers a small amount of gas at a rapid rate (as much as 60-100breaths per minute)
not used very much
TV + RR=
which effects CO2 level
FiO2 and PEEP effect:
imp ventilator setting that you will include in your vent order:
PSV (if appropriate)
Sensitivity (effort required for pt to take breath)
I Time ( inspir phase in sec's)
Pressure limit (top pressure during inspir)
ventilator settings to improve oxygenation (O2):
ventilator settings to improve ventilation (CO2):