Introduction to Respiratory Therapy: NIPPV LAB

any application of pressure without the use of an artificial invasive airway

Noninvasive ventilation (NIV)

oxygen given at higher flows than conventional oxygen flows on a flowmeter

High-flow oxygen therapy (HFOT)

name 3 heated high flow oxygen therapies

-Opti-flow

-Vapotherm

-Airvo

Applies a constant pressure during inspiration and expiration; May be invasive or noninvasive

continuous positive airway pressure (CPAP)

what three conditions is CPAP indicated for?

-OSA

-Pulmonary edema

-premature airway closure

noninvasive ventilation with two pressures (IPAP, EPAP)

Noninvasive positive airway pressure ventilation (NIPPV); BiPAP

what does BiPAP stand for?

Bilevel positive airway pressure

what are the two levels of pressure on BiPAP?

Inspiratory positive airway pressure (IPAP); Expiratory positive airway pressure (EPAP)

High pressure setting on NIPPV

Inspiratory Positive Airway Pressure (IPAP)

low pressure setting on NIPPV

Expiratory Positive Airway Pressure (EPAP)

this kind of therapy provides a high flowrate that washes out CO2 from anatomic dead space (does not provide a tidal volume)

High flow oxygen therapy

name the 3 oxygenation tools

CPAP=EPAP=PEEP

there is 1L of CPAP for every ______L of ________

10 liters of high flow oxygen therapy (HFOT)

does HFOT enhance the tidal volume, or wash out CO2?

wash out CO2; HFOT

DOES NOT ENHANCE TIDAL VOLUME

what interfaces can be used with heated high-flow devices?

-nasal cannula

-trach collar

which of the oxygenation tools is strictly invasive?

PEEP

which of the oxygenation tools is strictly non-invasive?

EPAP

which of the oxygenation tools can be either invasive or noninvasive?

CPAP

what causes cardiogenic pulmonary edema? which tool would we use to treat it?

Left sided heart failure; CPAP

what is the main requirement for a patient to be eligible for BiPAP use?

patient must be spontaneously breathing

pressure support formula

IPAP-EPAP

name the 4 primary settings you must set on BiPAP

-IPAP

-EPAP

-Backup rate

-FiO2

name two ways to fix oxygenation on NIPPV

-EPAP

-FiO2

what FiO2 should you generally initiate NIPPV with?

30%

we don't increase EPAP until we've increased FiO2 to _______%

60%

True or False: If you increase EPAP, you must also increase IPAP

TRUE: In order to fix only oxygenation, you must increase EPAP, and increase IPAP by the same amount to maintain *THE SAME PRESSURE SUPPORT*

True or False: To fix ventilation we must only increase IPAP, and NOT EPAP

TRUE: To increase the tidal volume/ventilation you must increase PRESSURE SUPPORT. Therefore you must leave EPAP alone, and only increase IPAP.

which pressure level alters ventilation?

IPAP

which pressure alters oxygenation?

EPAP

increased pressure support = increased ___________________

Tidal volume and minute ventilation

what is the standard initial BiPAP settings (numbers)?

10/5 or 12/6, 12, 30%

what is the name of our BiPAP? What mode do we use?

PHILLIPS V60; ST mode (spontaneous timed)

name 4 indications for NIPPV

-hypoxemic respiratory failure

-hypercapnic respiratory failure

-post-extubation bridge therapy

-DNI patients requiring ventilatory support

smaller pressure support = smaller

Tidal volume and minute ventilation

decrease in EPAP will ____________ oxygenation

decrease

what diagnostic tool do we use to influence our BiPAP settings?

ABG values

EPAP must be a minimum of __________

5 cmH2O

what kind of filter is inserted between the BiPAP and patient circuit?

Bacterial filter

we chart PIP as the same number as...

IPAP

Alarm settings: High and low airway pressure

High= 10-15 above PIP

Low= 5-10 below PIP

Alarm settings: High and low Rate (frequency)

High= 10-15 above total rate

Low= 5-10 below total rate

Alarm settings: High and low Ve

High= 2L above Ve

Low= 2L below Ve

Alarm settings: High and low Vt

High= 100cc above Vt

Low= 100cc below Vt

Alarm settings: Apnea/LIPt

20 seconds

when providing positive pressure ventilation, we must always be cautious of...

cardiac embarrassment

patient leak must be less than _________

50LPM

how would we fix a leak greater than 50lpm?

readjust or change face mask

what must we use when applying the face mask?

skin barrier

name the 4 patient interfaces for NIPPV

-nasal mask

-nasal prongs

-face mask

-full face mask

interface that covers just the nares and straps onto head

nasal mask

interface that sits at the bottom of the nose in the nares

nasal prongs

interface that covers the mouth and nose beginning at the bridge of the nose and sitting on the upper chin (most common in acute care)

face mask

interface that covers the entire face for patients with claustrophobia or certain traumas

full face mask

how long after initiating noninvasive positive pressure ventilation do we collect an ABG?

1 hour