2284L NPPV

Question 1

What NPPV stand for?

Answer 1

Non Invasive Positive Pressure Ventilation

Question 2

What are the goal for NPPV?

Answer 2

• Avoid Intubation
• ↓ Respiratory Rate, ↑ tidal volume
• Enhance gas exchange (↑PaO2, ↓PaO2)
• Decrease Cardiac Ouput
• Decrease Myocardial Oxygen demands

Question 3

Benefits of NPPV

Answer 3

• Reduce Mortality
• Reduced Mosocomial Infection
• Less Sedation
• Decreased Length of stay (LOS)
• Improve quality of care.

Question 4

Who gets NPPV

Answer 4

• Moderate to Severe Dyspnea
• Used of accessory muscles
• Paradoxial Breathing
• RR => 25 Breaths/min
• PaCO2 >45 mm Hg, PH < 7.35
• PaO2/FiO2 ratio <200

Question 5

Who do not gets NPPV?

Answer 5

• Apnea
• Hemodynamic or cardiac instability (Systoly BP < 90 mm Hg)
• Life-threatening refractory hypoxemia (PaO2 <60 mmHg on 100% O2)
• Uncooperative behavior
• Facial burns/facial trauma
• High risk of aspiration
• Copious secretion

Question 6

Why NPPV does not work on apnea patient?

Answer 6

Because NPPV is a patient effort dependent device, the patient must breath spontaneously in order to activate it.

Question 7

What kind of patient primarily use NPPV nasal Mask?

Answer 7

Nasal Mask are primarily for patients with Sleep Apnea

Question 8

What type of mask isprimarily use on NPPV?

Answer 8

Full Face Mask

Question 9

What are the Noninvasive Ventilators Modes?

*

Answer 9

• CPAP
• Spontaneous IPAP
• Spontaneous/Timed IPAP/EPAP

Question 10

NPPV Recommended Initial Setting is:

Answer 10

1. Spontaneous/Timed Mode
2. IPAP of 8 - 12 cm H2O
3. EPAP of 3 - 5 c, H2O
4. Back up Rate of 8 ( will be delivery only if the patient does not trigger a Spontaneous Breath)
5. Adjust FiO2 to keep SpO2 >90 - 92%

Question 11

What will happen to, Pressure, VT, and PaCO2 when IPAP is increased?

Answer 11

1. ↑ Pressure ( If we increase IPAP pressure will increase as well)
2. ↑ VT, (Increase pressure will increase Volume in the Lungs)
3. ↓ PaCO2 (Pressure increase Volume creatining more surface to gas difuse, decreasing PaCO2)

Question 12

What would you do to increase VT in a NPPV Device

Answer 12

Increase the pressure

Question 13

When we create a larger Vt, what happen to PaCO2?

Answer 13

Increased Vt means larger surface for gas to diffuse, decreasing PaCO2

Question 14

On NPPV the elevated base line pressure is called?

Answer 14

EPAP

Question 15

What does EPAP do?

Answer 15

It facilitate Oxygenation, by expanding the alveoli

Question 16

Once EPAP its already in place, the positive Breath aplied on top of that its called?

Answer 16

Ventilation,

Question 17

It’s the pressure difference between IPAP and EPAP?

Answer 17

Pressure Support

Question 18

TRUE or FAlSE.

Pressure Support ventilates the patient?

Answer 18

TRUE, (Now, if we adjust the IPAP we must adjust the EPAP to keep the same pressure Support, very important)

Question 19

How do we know if alveolar ventilation is adecate?

Answer 19

By doing a blood gas test (ABG)

Question 20

Exccessive pressre on NPPV can lead to?

Answer 20

• Nose Irritation
• Nasal congestion
• Headaches
• Gastro Consolidation

All these could happen when we brake pressures over 25 cm H2O