NONINVASIVE POSITIVE PRESSURE VENTILATION

Question 1

Indications, Conditions with best evidence for usage

Answer 1

Indications:
Rapidly reversible cause of respiratory failure with goal of resolution in 6-12 hrs

Conditions with best evidence for usage:
COPD
Cardiogenic Pulmonary Edema
OSA

Question 2

Criteria

Answer 2

Cooperative
Mod-severe dysnpnea
Tachypnea (>24 breaths / min)
Increased WOB
Hypercapnic Respiratory Acidosis (pH 7.0 - 7.35)
Hypoxemia (PA02/Fi02 < 200mmHg)

Question 3

Absolute C/I

Answer 3

GCS < 8
Resp / Card arrest
Condition requiring urgent intubation

Question 4

Relative C/i

Answer 4

Impaired LOC
Hemodynamic Instability
Impaired cough / swallow
Copious secretions
GI bleed with significant emesis

Question 5

BiPAP: Indications

Answer 5

MC NIPPV in ICU
COPD
Cardiogenic pulmonary edema

Question 6

BiPAP: Mechanism, EPAP mechanism / benefits, IPAP mechanism / benefits, PEEP

Answer 6

Delivers EPAP (Expiratory Positive Airway Pressure; essentially CPAP) and IPAP (Inspiratory Positive Airway Pressure) synchyronyzed respiratory cycle

EPAP Mechanism / Benefits: Improves oxygenation by provides PEEP -> preventing collapse of small airways + recruits alveoli -> Increase SA and gas exchange

IPAP Mechanism / Benefits: Pressure support on top of PEEP -> reduces respiratory effort, increases tidal volume, improves ventilation

Question 7

Starting & Titrating BiPAP

Answer 7

Start BiPAP at 15/8-10

THEN

Titrate to 20/8-10

Recheck ABG in 1-2 hrs Should see results in 2 hrs

Question 8

CPAP: Indication

Answer 8

Hypoxemic Respiratory Failure

Hypercarbic Respiratory Failure

Mixed Respiratory Failure

Question 9

CPAP: mechanism, PEEP

Answer 9

Continuous positive airway pressure delivered throughout respiratory cycle

Patient breaths spontaneously from elevated baseline pressure selivered throughout respiratory cycle

Improves oxygenation by keeping airways open and recruited

PEEP: 5 -10 cm H20

Question 10

HFNC (Airvo): PEEP and Indications

Answer 10

4-6 cm PEEP
Hypoxemic Respiratory Failure

Question 11

Predictors of Success

Answer 11

Decrease PaC02 > 8mmHg
↑pH > 0.06
Correction of respiratory acidosis

Question 12

Predictors of Failure

Answer 12

↓LOC: GCS<8, Encephalopathy score > 3
pH < 7.25, PC02 >80
Cannot tolerate mask
Inability to clear secretions
FAILURE TO IMPROVE AFTER 6-12 HRS (expect results within 2 hours)

Question 13

Complications

Answer 13

Facial Pressure Sores
Dry MM + Thick Secretions
Aspiration
Barotrauma