08: BiPAP

Question 1

definition of NPPV

Answer 1

Augment spontaneous ventilation

Question 2

NPPV standard of care

Answer 2

Acute respiratory failure by COPD exacerbation

Question 3

Acute care indications for NPPV

Answer 3

Hypercapnic respiratory failure (pH 7.35-7.22)
Asthma
COPD weaning
Hypoxemic respiratory failure (P/F <200)
Acute Cardiogenic pulmonary edema
Pneumonia
ARDS

Question 4

Long term indications for NPPV

Answer 4

Nocturnal hypoventilation
Restrictive thoracic diseases
ALS
COPD
Obesity hypoventilation
Sleep apnea

Question 5

Goal of NPPV

Answer 5

Improve gas exchange by resting respiratory muscles and improving alveolar ventilation

Question 6

Absolute contraindications of NPPV

Answer 6

Apnea
Untreated pneuomothorax

Question 7

Serious complications of NPPV

Answer 7

Aspiration
Pneumothorax
Hypotension

Question 8

Side effects of NPPV

Answer 8

Nasal congestion (use heated humidity)
Nasal dryness (heated humidity/nasal saline)
Sinus/ear pain
Eye irritation
Gastric distension

Question 9

Difference between CPAP and BiPAP

Answer 9

CPAP: 1 pressure (oxygenation)
BiPAP: 2 pressures (ventilation)

Question 10

IPAP

Answer 10

Controls ventilation (CO2)

Question 11

EPAP

Answer 11

Controls oxygenation (O2)

Question 12

IPAP - EPAP =

Answer 12

Pressure support

Question 13

The larger the difference in IPAP and EPAP

Answer 13

The larger the Vt

Question 14

BiPAP initial settings

Answer 14

IPAP: 8-10
EPAP: 4-5
RR: 8-10
FiO2 < 60%

Question 15

Spontaneous mode: set controls, pt controls, and what determines Vt

Answer 15

Set: IPAP, EPAP, FiO2
Pt: rate (no backup), and depth
Pt effort and IPAP - EPAP determine Vt

Question 16

Spontaneous/timed: set controls, pt controls, and what determines Vt

Answer 16

Set: IPAP, EPAP, rate, FiO2
Pt: triggers/cycles, but backup rate
Vt: pt effort and PS

Question 17

Timed mode

Answer 17

Moves from IPAP to EPAP by preset rate ONLY
Pt can superimpose SB

Question 18

Vt =

Answer 18

IPAP - EPAP

Question 19

CPAP

Answer 19

Single pressure constant during I and E
Pt controls: rate and Vt

Question 20

Pt success in NPV predictors

Answer 20

Minimal air leak (<50)
Low severity of illness
Respiratory acidosis
PH 7.22-7.35
Improve gas exchange within 1-2 hours
Improve HR and RR

Question 21

Delivery of SVN on BiPAP

Answer 21

Vibrating mesh

Question 22

Type of mask that improves Vt the most

Answer 22

Full/total

Question 23

Increased CO2 but normal pH?

Answer 23

Increase IPAP

Question 24

Decreased CO2 but normal pH?

Answer 24

Decrease IPAP

Question 25

Acceptable/normal CO2 and decreased O2?

Answer 25

Increase IPAP and EPAP incrementally the same

Question 26

Acceptable/normal CO2 and increased O2?

Answer 26

Decrease IPAP and EPAP incrementally the same

Question 27

Increased CO2 but decreased O2?

Answer 27

Increase EPAP by 2 and IPAP by 4

Question 28

Decreased CO2 but increased O2?

Answer 28

Decrease EPAP by 2 and IPAP by 4

Question 29

Type of humidity device for NPPV?

Answer 29

Passover

Question 30

Criteria for terminating NPPV

Answer 30

Worsening pH and PaCO2
Tachypnea
Hemodynamic instability
SpO2 <90%
Decreased LOC
Cannot clear secretions
Cannot tolerate interface

Question 31

Weaning process for NPPV

Answer 31

Increase time off mask

Question 32

Interface related side effects?

Answer 32

Ulcer/rash
Claustrophobia

Question 33

Goal of interface

Answer 33

Minimize leakage and maximize pt comfort

Question 34

Pt hypoventilating?

Answer 34

Increase VE

Question 35

Pt hyperventilating

Answer 35

Decrease VE

Question 36

3 basic methods for NPPV

Answer 36

Negative pressure
Abdominal displacement
PPV