non-invasive ventilation

Question 1

what is a Diaphragmatic Pacing

Answer 1

surgically implanted nerve stimulator which
allows for ventilatory support in selected
patients with chronic ventilatory insufficiency

Question 2

indication of Diaphragmatic Pacing

Answer 2

• central alveolar hypoventilation
• brainstem injury or disease
• spinal cord injury or disease at or above C3-C5
• damaged phrenic nerve(s)

Question 3

what are the criteria for using diaphragmatic pacing

Answer 3

• intact nerves with normal function
• adequate lung function with normal
  compliance
• ability to understand and manage pacing
• patent upper airway

Question 4

Contraindications of Diaphragmatic Pacing

Answer 4

• phrenic nerves degenerated
  • no diaphragmatic response to electrical
  stimulation
  • compromised lung function

Question 5

what is the components of a Diaphragmatic Pacing

Answer 5

• Electrodes
• -> monopolar or bipolar
• Receiver
• Transmitter
• Antennae

Question 6

fxn of Transmitter

Answer 6

sets respiratory rate and
length of inspiration (powered by battery)

–generates a coded
radiofrequency signal, so that it cannot be disrupted

Question 7

fxn of Antennae

Answer 7

transfers signal across intact

skin to the receiver

Question 8

fxn of Receiver

Answer 8

obtains signal and energy from
external portion by inductive coupling.The
receiver is placed in a subcutaneous pocket

Question 9

fxn of Electrodes

Answer 9

stimulates the phrenic nerve

Question 10

What are the controls of the transmitter?

Answer 10

• On switch
• RR control (# of pulse
  trainsmitted/min)
• Insp Period (It )
• Three controls for Vt
  …. Stimulus Amplitude
  … Pulse interval
  …. Pulse Width

Question 11

Benefits of Diaphragmatic Pacing

Answer 11

• Cost effectiveness
• Lower infection rates
• Improved venous return
• Normal breathing and speech return
• Ease of eating and drinking
• Increased patient mobility

Question 12

how to clean pacer

Answer 12

Autoclave electrodes and antenna/radio receiver
before implanting. Do not gas sterilize…ETO
residue or other chemicals can cause severe tissue
reaction

Question 13

What is the indication of NIPPV?

Answer 13

• Hypoventilation syndromes
• OSA and CSA
• Palliative

Question 14

wat is the contraindiation of NIPPV

Answer 14

• Inability to protect airway
• –> Secretions
• –> Patent
• Pressure related complications
• –> Sinusitis etc
• Inability to use interface properly
• –> Facial issues
• –> Cooperation
• High FiO2

Question 15

What are the devices used for NIPPV?

Answer 15

Conventional ventilators

Bi Level Devices

Question 16

wt are the bilevel device used ?

Answer 16

BIPAP(respironics), VPAP(resmed)

Question 17

what are te modes of BiPAP

Answer 17

• CPAP
• S
• S/T
• T
• PC

Question 18

what are the therapy features of bipap

Answer 18

• AVAPS
• AVAPS rate
• Bi-Flex٭
• Ramp
• Rise Time٭
• Digital Auto-Trak

Question 19

external Battery of Bipap?

Answer 19

Up to 5 hours Power

Question 20

what are the main settings of Bipap

Answer 20

• IPAP 4 to 40cmH2O
• EPAP 4 to 25cmH2O
• BPM 0 to 40

Question 21

what is the purpose of AVAPS

Answer 21

AVAPS will help patient maintain a VT equal

to or greater than the set VT

Question 22

how does AVAPS achieve its fxn

Answer 22

automatically controlling the PS provided to the patient

- by varying the IPAP level between the IPAP Min and IPAP Max settings (or PSmin and PSmax)

Question 23

Which mode is biflex available in

Answer 23

S mode

same as Cflex in CPAP

Question 24

indication of VPAP?

Answer 24

provide noninvasive ventilation due to respiratory

insufficiency or OSA patients >30 lbs

Question 25

fxn of vsync of VPAP

Answer 25

adjust the baseflow so that patient doesnt have to work as hard to trigger

Question 26

what does high, ed, low trigger and cycling mean

Answer 26

high-->easiest | low-->hardiest

Question 27

fxn of IBR

Answer 27

Intelligent Back Up Rate it mimics patient breathing pattern in the background, when patient goes apneic, ventilator will provide breath similar to patient pattern

Question 28

What is IVAPS

Answer 28

Intelligent volume-assured pressured support

Question 29

indication for IVAPS

Answer 29

patient over 66ibs

Question 30

indication for stellar

Answer 30

provide ventilation for nondependent, spontaneously breathing pt with respiratory insufficiency, or respiratory failure, with or without OSA

Question 31

what are some common alarms used in BIPAP, VPAP, stellar

Answer 31

- Power failure - Apnea (not on VPAP3) - Low pressure - High pressure - Low volume

Question 32

how is fio2 affected in these machine

Answer 32

by flow and leak

Question 33

How are patient qualified for CPAP

Answer 33

documented sleep apnea – level 1 polysomnography AND significant symptoms/risks that are reversed with treatment

Question 34

How are patient qualified for Auto-Titrating Positive Airway Pressure APAP

Answer 34

1.qualified for CPAP AND 2.patients with prescribed fixed CPAP level of 10 cmH2O a minimum change of 4cmH2O between REM and NREM

Question 35

What does the ADP funding package include for BIPAP, CPAP and APAP?

Answer 35

(i) a positive airway pressure device; (ii) a heated humidifier; (iii) a basic mask and headgear; (iv) carrying case; (v) 6 ft. tubing; (vi) all necessary caps and filters, (vii) user instruction manual **patient dont have to pay out of the pocket for these components