BIPAP vision

Question 1

Can BIPAP be used invasively?

Answer 1

NO

Question 2

IS BIPAP a life support?

Answer 2

NO

Question 3

what interfaces can bipap used with?

Answer 3

1) a single limb, open circuit with intentional leak on patient face mask
2) used for non-life supported invasive ventilation if properly equipped

Question 4

Does BIPAP have a backup battery for system?

Answer 4

NO

Question 5

What is the Rechargeable battery for?

Answer 5

the operation of the alarm

Question 6

What is the pnuematic source of BIPAP

Answer 6

• High pressure Oxygen
• ->it can function without O2
• blower
• ->draws ambient air in

Question 7

What control the output flows in BIPAP

Answer 7

PVA (pressure valve assembly)regulates system flow and pressure

Question 8

What is the air flow through the BIPAP pneumatic system?

Answer 8

ambient air–>filter–>blower–>PVA(pressure valve assembly) –> pass through the exhaust –>AFM (airflow sensor) –> patient circuit

Question 9

What are the controlled pressure valve in BIPAP?

Answer 9

1 controls IPAP

1 acts as exhaust to maintain EPAP

Question 10

How is pressure maintained?

Answer 10

Based on IPAP and EPAP settings
–> control circuit adjusts the electrical current in the pressure valve coil

–>The electrical current, in combination with a magnetic field, produces a force on the valve disc

–> this force produced must equal the force created by the air pressure to maintain a stable pressure

Question 11

How does PVA adjust the pressure?

Answer 11

by controlling the amount of flow going to the patient via the exhaust

Question 12

What is the exhaust function?

Answer 12

fxn similar to a exhalation valve

Question 13

What is the AFM (air flow module)

Answer 13

detect the pressure and flow from the proximal pressure line, which signals the exhaust and blower to initial its adjustment

Question 14

how does the blower adjust the fow

Answer 14

by varying its speed

Question 15

Where is the proximal line enter to the system?

Answer 15

flow of gas entering before the AFM

Question 16

how to add supplementary flow in BIPAP

Answer 16

1. add flow a mask port (up to 15 lpm

2. add flow at machine outlet

Question 17

What function is needed to be activated after adding supplementary flow

Answer 17

LEARN BASE FLOW

Question 18

What are the total leaks of the BIPAP

Answer 18

fixed leak + unintentional leak

Question 19

What are the total flow consisted in in BIPAP?

Answer 19

total flow = estimated flow (going into the patient) + (unintentional + fixed) leak

Question 20

what is the fxn of Exhalation Port Test

Answer 20

Measures intentional leak from exhalation port

Question 21

What is the display if Exhalation Port Test isnt done

Answer 21

tot leak

Question 22

What is the display if Exhalation Port Test is done

Answer 22

Pt leak

Question 23

when to perform exhalation port test? and why

Answer 23

when mask is changed

because it measures the fixed leak of the new mask to calculate baseline leak

Question 24

What is the function of Auto-Trak Sensitivity

Answer 24

recognize and compensate for unintentional leaks

Question 25

How does the Auto-Trak Sensitivity work

Answer 25

adjust its trigger and cycle based on Tidal Volume or Expiratory Flow rate

Question 26

How does the Auto-Trak Sensitivity use expiratory flowrate ?

Answer 26

1) it measures the baseline flow 5 sec after the start of cycling 2) if the flow is above the baseline flow ( which is 0), it assumes unintentional leak 3) it d then adjust the flow by comparing the current leak and previous leak flow

Question 27

Why does the VT relate to the leak

Answer 27

1) Unit assumes volume into the pt. = volume out of pt. 2) If the volume out is greater, assumes the extra volume is unintentional insp leak volume. 3) Volume will be adjusted based on the calculation If more volume results in increase baseline leak --> the new volume given will be less

Question 28

What is the trigger of BIPAP

Answer 28

Volume - 6cc inspired volume accumulates above baseline flow, trigger by patient Shadow/shape signal - when the shadow waveform meet the actual waveform

Question 29

how does the Shape Signal | work?

Answer 29

follows” the flow pattern, at 15 lpm less flow, 400msec “behind” the pt. flow - helps with triggering and cycling

Question 30

What cycles BIPAP

Answer 30

1. Shape Signal (same as triggering) 2. Spontaneous Expiratory Threshold (SET) 3. Flow reversal 4. Time back up

Question 31

how does the SET work

Answer 31

Electronic signal that rises in proportion to the inspiratory flow rate on each breath - signal will rise until it intersects with the inspiration, then cycle

Question 32

how does flow Reversal work

Answer 32

1. Cycles out of IPAP if large leak occurs | 2. while the flow is decelerating, it then accelerates in response to a large leak

Question 33

What is the I time backup for cycling

Answer 33

3 sec

Question 34

What are the mode of BIPAP

Answer 34

• CPAP (spontaneous) • PSV (IPAP/EPAP) • Spontaneous/timed (S/T) - PAV/T

Question 35

What is the setting for CPAP mode

Answer 35

CPAP, FiO2 RATe

Question 36

What is the setting for S/T mode

Answer 36

``` IPAP, EPAP, Rate I time rise time FiO2 ```

Question 37

When does S/T switch to time mode

Answer 37

when spont RR drops below set rate, vision deliver PC breath (set IPAP and I TIME)

Question 38

how to tell if the time mode is activated

Answer 38

‘V’ appears on VT waveform

Question 39

how does the PAV/T work

Answer 39

Delivers pressure in proportion to effort

Question 40

settings of PAV/T

Answer 40

- % set, - Maximum Volume Assist, - Maximum Flow Assist If patient fails to trigger the breath --> becomes a time breath - Back up rate and other parameters (IPAP, EPAP, I time, rise time)

Question 41

When does the exh port alarm go off

Answer 41

baseline flow is < 5 L/min or 50% of intentional leak for one minute

Question 42

when does the Hi P go off

Answer 42

Proximal pressure > setting for > 0.5 second

Question 43

when does the low pr go off?

Answer 43

Proximal pressure below criteria for duration of Low pressure delay

Question 44

What is low pressure delay

Answer 44

the maximum amount of time allowed for proximal pressure to be lower than the set Low P

Question 45

when is learn base flow activated?

Answer 45

- After changing circuit | - After adding flow to the circuit

Question 46

what are the precaution when using BIPAP

Answer 46

1 . Pt. must be able to support their ventilation and protect their airway 2. DO NOT use a HME--interferes with flow sensing capabilities