6. Ventilatory Support Flashcards
Sx of OSA
Snoring framed by breathing pauses
Excessive daytime sleepiness ( maybe even during driving)
Ix of OSA
Home sleep study- AHI
Only consider polysomnography of unclear or no high AHI index
WHat is needed for Dx of OSA
- 15 apnoeas → desaturation of more than 4%
- If less than 15 can do polysomnography
What diseases is sleep apnoea assoc with
- Assoc with hear disease/ CV disease
- cognitive impairment
- RTA
when is CPAP used and when is BIPAP used
CPAP for OSA, BIPAP for acute TIIRF and COPD exacerbations
When can domicillary NIV be given
- if have chronic respiratoru hypercapnoea
- 2 levels of pressure delivered
- Designed to reverse TIIRF by increasing ventilation
- Chronic TIIRF eg.. NM failure, MND etc
Which pts can be given LTOT
- For chronic hypoxaema
- PaO2 < 7.3, checked x2 3 weeks apart, 6 weeks since exacerbatn
- Slow progression of pulm HTN, decrease in mortality
When should pneumonia patients be admitted or sent to ICU
3 or more
What is target SPo2 for acutely unwell pts ( both scales)
94-98% vs 88-92 if risk of chronic hypercapnoea
When should venturi mask be given
If target 88-92 or unwell with type I
oxygen range from venturi
Fio2 24-60%
Define RF
- PaO2 < 8kPa * breathing air
- or PaCo2 >6.5 kPa
Possible compensation for hypoxia
Mild resp alkalosis due to blowing off Co2
If pt is hypercapnic and Pa02>8, is this RF
yes
pH in chronic TIIRF
may be normal due to raised bicarb to compensate for resp acidosis
Primary resp acidosis with sec metabolic alkalosis???
Acute on chronic TIIRF tx
give venturi and reduce oxygen supplementation so pH comes up. If pH doesn’t come up then give NIV
What does +ve and +ve BE mean1
High means alkalosis, low means acidosis
Compensation for metabolic acidosis
Kussmaul breathing, hyperventilation to blow off co2
what drugs can cause respiratory depression, CO2 retention and hypoxia
BENZOs
What does it mean if there are more lung markings centrally than periphally
Could be pneumothorax
What does reduced lung markings peripherally possibly suggest
CF exacerbation
