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ARTP > 03: IPPB > Flashcards

03: IPPB Flashcards

(56 cards)

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1
Q

Define IPPB

A

Intermittent positive pressure breathing

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2
Q

Goals of IPPB

A 
#1 short term vent support
Lung expansion
Deliver aerosol (pt w muscle fatigue)
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3
Q

Indications for IPPB

A 
#1 true: increase ventilation in pt unable to take deep breath
Unsuccessful IS
Prevent/treat atelectasis
Inability to move secretions/cough
Alternate to mechanical ventilation
Decrease dyspnea
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4
Q

Absolute contraindication of IPPB

A

Untreated tension pneumothorax

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5
Q

Relative contraindications for IPPB

A 
Increased ICP
Face surgery
Tracheoesophogeal fistula
Nausea
TB
Hemoptysis
Hemodynamic instability
Blebs (increases barotrauma)
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6
Q

IPPB tx hazards

A 
#1: increased Raw and WOB
Barotrauma
Hyperventilation
Hyperoxia
O2 induced hypoventilation
Decreased venous return
Increased alveolar dead space
Impacted secretions
Increase VQ mismatch
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7
Q

How to minimize decreased venous return

A

Decrease pressure to increase ventilation

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8
Q

Adverse reactions to IPPB

A

Pneumothorax

Pulmonary edema

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9
Q

Patients benefitting from IPPB

A

Atelectasis
Neuromuscular diseases
Abnormal chest circumference -> decreased LV

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10
Q

IPPB effect on WOB

A

Decrease

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11
Q

IPPB effect on ventilation

A 
Decreased dyspnea (increasing Vt)
Increased oxygenation (1:2)
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12
Q

IPPB blood gas measurements during tx

A

Increased V/Q
Increased PaO2
Decreased PaCO2
N/increased pH

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13
Q

IPPB effect on cardiovascular function

A

Improved HR

Decreased venous return

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14
Q

IPPB order should include

A

Tx to be delivered
Frequency
Duration
Medication

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15
Q

What to monitor during IPPB therapy

A 
Machine performance (sensitivity, peak pressure, inspiratory time, FiO2)
Delivered Vt
Pt response (appearance/sensorium/LOC)
VS
Other: skin color, sputum, ICP, CXR
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16
Q

Bird Mark 7 operational principles

A 
Pneumatic
Pt triggered (pressure cycled)
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17
Q

What is pressure cycled

A

Inspiration ends when pressure preset limit has been reached

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18
Q

Initial setting for Bird Mark 7

A

10-15 cmH2O

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19
Q

Bird Mark 7 controls

A 
Pressure (cycle/stop)
Sensitivity (trigger)
Flow
Air dilution
Expiratory timer
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20
Q

Bird mark procedure

A 
Set driving pressure (PIP)
Pt triggers machine (decreasing line pressure(
Gas moves to aw
Preset PIP reached (gas shuts off)
Inspiratory phase cycled off
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21
Q

Bird mark 7 trouble shoot: breath/machine wont cycle on

A

High pressure line -> gas source
Turn on flow
Check sensitivity -> set to autocycle -> then turn back a little
Tight seal, nose clips, etc

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22
Q

Bird Mark 7 troubleshoot: dizzy/finger tingle/light headedness

A

Pt breathing too deep: relax

Hyperventilation: slow RR

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23
Q

Bird Mark 7 troubleshoot: no cycle off

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A 
Check flow rate (might be too slow)
Check for leaks
Tight seal
Check mushroom valve
Nebline/cup
Mainline
For leaks
24
Q

Birdmark troubleshoot: inhalation >1-1.5 sec

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A

Flow too slow
Check for: small leaks, manometer pressure, air mix
Air mix 100%? Loss of air entrainment, increase flow

25
Bird mark troubleshoot: breath starts too easily
Sensitivity too low | Machine triggers by itself? Autocycle
26
Bird mark troubleshoot: no steady rise in manometer on inspiration
Pt over breathing flow | Increased set flow
27
What to document post IPPB
Pre/post VS Dosage and diluent Untoward responses Duration
28
Assist mode
Only pt can trigger
29
Assist/control mode
Set # of bpm, but pt can trigger additional
30
Control mode
Triggers only at pre-set frequency
31
Exhalation valve
Gas only to pt on inspiration, cycles off | Passive exhalation via same circuit
32
Flow rate
How fast pressure limit reached Increased flow = decreased inspiratory time Decreased flow = increased inspiratory time 1-1.5 sec
33
Pressure limit
Change in LC Decreased Lung compliance = decreased tidal volume Increased LC = increased Vt
34
Too much pressure leads to
Increased alveolar dead space, barotrauma, and decreased venous return
35
Percent oxygen able to be delivered w bird mark
40% or 100%
36
Minimum delivered Vt
1/3 predicted inspiratory capacity
37
IC calculation
50 ml/kg of ideal body weight
38
Ideal body wt calculation
Males: 50 + 2.3(ht (in) - 60) Females: 45.5 + 2.3(ht - 60)
39
Increased Mean Alveolar Pressure means there is a
Greater potential for decreased venous return
40
Factors affecting delivered FiO2
Pt LC Set flow rate Pressure limit Venturi gate function
41
Volume cycled
Delivers certain volume then stops
42
Flow capability of bird mark
80 lpm in air mix | 50 lpm in 100% O2
43
Pressure chamber
Pt filter (R on machine)
44
Ambient chamber
Filter (L on machine)
45
Optimal breathing technique (rate, I:E, insp. Hold)
6-8 bpm 1:2 3-5 seconds
46
Length of inspiration in pressure cycled ventilator
Determined by pre-set pressure and pt compliance?
47
Sensitivity control determines
Negative pressure needed to trigger inspiration
48
Pressure control determines
Change in lung compliance with positive pressure ventilation
49
Pt most prone to barotrauma
Pt with emphysematous blebs
50
Flow rate determines
How fast pressure limit can be reached
51
What entrains air in bird
Ambient chamber
52
Alveolar dead space causes
Decreased capillary bf return
53
If the sensitivity is too low the machine will
Autotrigger
54
Pressure manometer measures
How much pressure going to pt
55
How to identify leak in pressure/volume cycled ventilator
Won’t cycle off
56
Assess effectiveness of IPPB
``` Increased PEF rate Vt 1/3 predicted vol Improved cough/secretion clearance Reduced dyspnea Improved oxygenation ```

ARTP (9 decks)

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