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1. how does CPAP therapy work?
2. what is the pressure range for CPAP?
3. what does it require to provide & maintain flow?
1. pt breathes through a pressurized circuit against a threshold resistor
2. 4-20 cm H20
3. requires apressurized gas source
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what happens to lung compliance when the alveoli collapse? what can help this ?
decreased lung compliance, CPAP can help this.
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what are the physiologic effects of CPAP therapy? (4)
1. recruitment of collapsed alveoli
2. increased lung compliance resulting in decreased work of breathing
3. improved distribution of ventilation
4. improved secretion removal
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what are 3 indications of CPAP therapy?
1. treatment of atelectasis
2. treatment of pulmonary edema
3. treatment of sleep apnea (they use a baseline pressure to keep airways open)
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what are 6 contraindications to using CPAP therapy?
1. hemodynamic instability (can mess up venous return)
2. hypoventilation
3. nausea
4. facial trauma
5. elevated ICP (concerened about venous return)
6. untreated pneumothorax
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if a patient has a PC02 of 60 mmHg on CPAP what should you do?
put pt on BIPAP (has 2 levels) so that they can move out the C02
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what are 5 hazzards of using CPAP therapy?
1. increased WOB (difficulty w/ flows they have to breath against)
2. hypoventilation
3. barotrauma
4. reduced venous return
5. gastric distension when pressures exceed 20 cmH20
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what are 3 ways of delivering CPAP therapy?
1. free-standing ( blender or kaskade)
2. downs adjustable flow generator (black venturi device)
3. EzPAP ( depends on pt insp flow demand)
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1. what is a "downs adjustable flow generator" ?
2. what 2 things do you have to check after each adjustment?
3. what 2 things are necessary for the safe use of this system?
4. what type of monitor is recommended to use with this generator?
1. a venturi powered device for the generation of continuous positive airway pressures
2. oxygen concentration & adequacy of flows
3. positive pressure relief valve and inlet valve
4. airway pressure monitor
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what is the therapudic pep range?
10-20 cm H20
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what 2 things does EzPAP combine?
pt negative pressure breathing and all of its benifits w/ a positive expiratory pressure.
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EzPAP uses what type of process that aguments flow upon inspiration?
what does that agumentation do for the patient?
is there PEP in EzPAP? .. if so, when?
1. fluidic process
2. it provides for a larger flow and volume w/less effort than an unsupported inspiration
3. PEP is provided during expiration
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what is the LPM range for EzPAP?
how should you instruct the pt to breath?
can it be used w/ aerosol medication?
1. 5-15 LPM
2. breath diaphragmatically
3. yes, via a 22 mm connection between EzPAP and pt.
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what things should you monitor on a pt when administering CPAP therapy?
1. Hypoventilation
2. Loss of pressure
3. system leaks
4. gastric insufflation
5. insufficient
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Do BIPAP and CPAP provide continuous flow?
yes
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Who are the respiratory assist devices (such as BiPAP or CPAP) normally prescribed to?
to people w/ mild to moderate inspiratory muscle weakness and under vetilation
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How does the in BIPAP increase the delivered Vt?
by manipulating the delta P
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BIPAP:
1.what is delta P ?
2.what determines the patients Vt?
3. IPAP increases in increments of ___.
4. what is a good starting level?
1. delta P is the difference between IPAP and EPAP
2. the patients inspiratory effort and pulmonary mechanics determine the Vt
3. 2
4. 8-10 cm H20
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what can you check to confirm that you are helping the pt?
check their blood gases
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what does IPAP, delta P, and EPAP seperatly effect?
IPAP- highest pressure
Delta P- (breath) effects CO2
EPAP- oxygenation
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1. what does Delt P support?
2. how can you change a patients Vt?
3. what happens when you decrease delta P?
1. Delta P = pressure support
2. manipulate delta P to change Vt
3. decreasing delta P (support) will make the patient have to work more to breath
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what is the baseline of BIPAP that effects oxygenation?
EPAP
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what happens when you increasing Delta P ?
increasing delta P will decrease CO2.
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1. EPAP is used to increase what?
2. When you increase EPAP what else should you also do and why?
3. You should increase in increments of what? what should be the starting level?
1. EPAP is used to increase FRC
2. Increase the IPAP by the same amout to maintain the same pressure support level ( delta P ).
3. Increase in incremets of 2 from a startig level of 4.
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Explain each of these modes of BIPAP therapy.
1. Spontaneous
2. Spontaneous/Timed
3. Timed
4. CPAP
1. spontaneous- pt triggered only
2. spontaneous/times- pt triggered w/ a back up rate if the pt fails to initiate a breath
3. timed- unit cycles between the IPAP and EPAP levels based soley on a timing mechanism as determined by the BPM and % IPAP
4. CPAP- CPAP pressure level only, pt must be ventilating spontaneously
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what does BIPAP have that helps to eliminate CO2?
delta P
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what must a pt be able to maintain to be able to use CPAP?
must be able to maintain CO2
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What should the RT do if large negative pressure swings early in inspiration? what does this indicate?
this indicates an incorrect sensitivity or trigger setting, the RT should increase the sensitivity or alter the trigger level until only 1-2 cm H20 is needed to trigger the device into inspiration.
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what should the RT do if the system pressure decreases after inspiration begins or fails to increase steadily until the very end of the machine breath? what is the problem?
the problem is that the flow is too low, the RT should increase the flow (as tolerated) until system pressure increases steadily and holds near the preset value.
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if a pt needs high FiO2 what machine should u choose?
the IPPB bird machine
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