NIV/NIPPV Flashcards
Benefits of NIV
reduces need for intubation reduces hospital/ICU stay reduces nosocomial pneumonia reduces mortality preserves pts airway defenses improves comfort useful for pre-oxygenation
chronic:
helps with sleep apnea
What is CPAP
continuous positive airway pressure
provides same pressure for full resp cycle
Can all non-invasive and invasive deliver CPAP?
Yes
Does trapped gas from high-flow act as a CPAP?
If so, at what pressure and what does it improve?
2-5 cmH2O
improves oxygenation
What will happen to the CPAP in the lungs if we increase set flow OR pt closes his mouth?
CPAP will increase in the lungs
What does BiPAP stand for?
Bi-level positive airway pressure
What control mode can NIPPV be used on?
P/C, V/C or both?
Both
Primary goal of NIPPV acute and chronic
acute:
prevent intubation by improving gas exchange. reducing nosocomial infection, vap, airway trauma, patient discomfort
Improving alveolar minute ventilation = reduce CO2
chronic:
improve pt’s quality of life and reduce hypoventilation
Acute indications for NIPPV
Hypercapnic RF COPD exacerbation acute cardiogenic PE asthma post extubation RF post op RF faciliate extubation for COPDers hypoxemic RF (cautiously) RF in immunocompromised pts
Chronic indications for NIPPV
Nocturna; hypoventilaion ALS (amyotrophic lateral sclerosis) Restrictive thoracic diseases COPD OHS (obesity hypoventilation syndrome)
What does SVN stand for?
small volume nebulizer
What does DPI stand for?
dry powdered inhaler
What does MDI stand for?
metered dose inhaler
Can pts receive antibiotics, bronchodilators and ICS through the aerosol route?
Yes
What mask should be used if using a critical care ventilator for NIPPV?
Non-vented mask
What mask should be used if using a non-invasive ventilator for NIPPV?
Vented mask
How would you increase the flow through the exhalation port and minimize CO2 re-breathing?
Increase the EPAP
What are two risks of using HME with NIPPV?
Increase resistance & WOB
What are two benefits of using HME with NIPPV?
Costs & simplicity
What are complications of NIPPV via nasal mask?
nasal dryness, congestion, resistance, dry mouth
How much water does our respiratory tract evaporate everyday?
400 grams H2O
How to catch a tachypneic pt with NIPPV
RR >30 bpm
Ineffective tidal volume
How to predict success when using NIPPV
Improvement of gas exchange decrease PaCO2 normal pH increase PaO2 and SpO2 Increased Vt relaxes muscles normal HR within 1-2 hours
How to predict failure when using NIPPV
No improvement in pH, PaO2 and PaCO2
continued or increased respiratory distress
Worse LOC
= intubation should be considered especially if hypoxemic
Inability to clear secretions
