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RESP 5017 > 9. Neonatal Non-Invasive Ventilation > Flashcards

9. Neonatal Non-Invasive Ventilation Flashcards

1
Q
  1. what does NIV use to provide respiratory support? what is not used?
  2. what two types of equipment can be used to provide NIV?
  3. what two modes can be used with NIV?
A
  1. using a mask or prongs, an ETT is NOT used
  2. mechanical ventilator OR non-invasive machine
  3. NCPAP - Nasal Continuous Positive Airway Pressure and NIPPV - Non Invasive Positive Pressure Ventilation
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2
Q
  1. what 3 devices can be used to provide NCPAP?
  2. what 3 devices can be used to provide NIPPV?
  3. what other two types of ventilation can be used to provide NIV?
A
  1. bubble CPAP, ventilator CPAP, infant flow SiPAP (CPAP)
  2. ventilator NIPPV, infant flow (BiPhasic), NIV NAVA
  3. NHFOV and HFNC
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3
Q
  1. what are the 7 benefits of CPAP?

2. what does increasing FRC help to do? (hint: 6)

A
  1. improves oxygenation, decreases WOB, increases FRC, breathing pattern becomes regular, decreases central and obstructive apneas, keeps airways open and reduces inspiratory resistance by dilating the airways
  2. recruitment of collapsed alveoli, increased alveolar surface area, decreased intrapulmonary shunting, increased lung compliance, conserves surfactant, and decreases alveolar edema
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4
Q

what are the benefits of NIPPV? (hint: 6)

A
  • all benefits of CPAP
  • improved lung recruitment and increase to PIP
  • higher MAP
  • increased Vt and Ve
  • increase/augmentation of respiratory cycle
  • decreased WOB
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5
Q
  1. what are the indications for nasal CPAP? (hint: 8)
  2. premature infants should be considered for CPAP/NIV as long as they are able to demonstrate adequate ventilation, this is defined by what? (hint: 2)
A
  1. spontaneously breathing babies with respiratory distress, increased WOB (grunting, nasal flaring, increased O2, tachypnea), poorly expanded or infiltrated lung fields on x-ray, pulmonary edema, apnea of prematurity, tracheomalacia or airway abnormalities, preventing intubating and post extubation
  2. PaCO2 < 55 mmHg and pH > 7.25
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6
Q

what are the common complications of NCPAP/NIPPV? (hint: 5)

A
  • pneumothorax
  • agitation
  • continued deterioration
  • nasal trauma, tissue breakdown
  • gastric inflation
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7
Q

what are the common contraindications to NCPAP/NIPPV? (hint: 5)

A
  • severe ventilatory failure (may need to be intubated)
  • tracheo-oesophageal fistula
  • diaphragmatic hernia
  • severe cardiovascular instability
  • cleft palate
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8
Q

what are the 4 different methods/machines to provide NCPAP/NIPPV?

A
  • ventilator CPAP
  • bubble CPAP
  • infant flow CPAP/BiPhasic
  • non invasive positive pressure ventilation
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9
Q
  1. what determines the CPAP level with the bubble CPAP device?
  2. how many limbs in the circuit?
A
  1. determined by the depth of the straw in the water

2. inspiratory and expiratory (2)

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10
Q
  1. what does the bubble CPAP pressure manifold do specifically?
  2. what does this manifold allow?
  3. what is the adjustable CPAP level for the bubble CPAP generator?
  4. what does this generator do specifically?
  5. what does this generator include? where is the mounting bracket located?
A
  1. limits the pressure delivered in the event of an occlusion
  2. allows connection to a pressure monitoring device and/or an air/oxygen analyzer
  3. 3-10 cmH2O
  4. detachable overflow container allows uninterrupted CPAP when overflow container is being emptied
  5. includes a separate fill funnel, bracket located on the back of the bubble CPAP generator
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11
Q
  1. what is the ideal flow setting for the bubble CPAP? what is the full range?
  2. how do you set the CPAP level?
  3. what do you want to ensure that you see? what does this mean if you see this? what does it mean if you do not see this?
A
  1. ideal = 6-8 lpm, full range = 6-15 lpm
  2. by placing the appropriate depth of the straw in the water
  3. want to see bubbling! - Means there is a tight seal with nasal prongs
    if not seen = something wrong in the system or there may be a leak in the system
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12
Q
  1. what do you want to check before starting a leak test on the bubble CPAP machine?
  2. what is the CPAP level and flow set to when performing a leak test?
  3. what do you want to see for the machine to pass the test? what does it mean if this is not present?
  4. what do you do if the machine does not past the test?
A
  1. all connections are tight before use
  2. CPAP of 10 cmH2O and a flow of 1 L/min
  3. want to see gentle, audible bubbling, no bubbling means unacceptable leakage
  4. check entire system, remove port cap from pressure manifold before connecting any monitoring device
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13
Q
  1. what 3 modes does the infant flow machine provide?

2. why is this machine being phased out? (hint: 2)

A
  1. SiPAP, BiPhasic and CPAP
  2. moving to wanting a ventilator that does it all and limited to no more than 10 cmH2O that can be given therefore, used on larger/stable patient’s
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14
Q
  1. what does fluidic flip action help to minimize and during what phase of the respiratory cycle?
  2. what is the expiratory tube connected to? what does it function as? what does this allow for? (hint: 2)
  3. how does the expiratory tube function on inspiration?
  4. how does the expiratory tube function on expiration?
A
  1. WOB during expiratory phase using the Coanda effect and fluidic flip
  2. not connected to anything!! - functions as a reservoir allowing patient to get more flow and O2 if they need it and maintains the pressure in the circuit
  3. as flow goes in, pulls in gas from reservoir as well so patient is getting enough flow
  4. gas flow flips and provides resistance when exhaling to maintain the pressure
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15
Q
  1. what does SiPAP stand for? how does this mode generally work in the infant flow machine? why is this mode not widely used?
  2. what does Biphasic mean? how does this mode generally work? what is this mode independent of?
A
  1. Synchronized Intermittent Positive Airway Pressure, Synchronized rises above baseline CPAP with use of abdomen breathing sensor to “synchronize.” Not commonly used because abdomen sensor not very accurate
  2. Bilevel Nasal CPAP - timed bilevel pressure rise above baseline CPAP, independent of patient respiratory cycle
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16
Q
  1. what can small incremental increases of 2-4 cmH2O help to do with Bilevel nasal CPAP?
  2. what is the pressure limited to?
  3. what does Bilevel help to do for unstable alveoli?
  4. is Bilevel synchronized to patient effort?
A
  1. helps to augment FRC and can offload respiratory WOB (small puffs, recruit alveoli)
  2. 10 cmH2O
  3. recruitment and stabilization of unstable alveoli
  4. NO
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17
Q
  1. what is CPAP pressure determined by?

2. a flow of 8 lpm will deliver what CPAP pressure?

A
  1. flow setting

2. 5 cmH2O

18
Q
  1. what is the upper pressure (PIP) delivered during Biphasic created by? what does this cause?
  2. a total flow of 12 lpm will deliver what CPAP pressure?
A
  1. an increase in flow causing an increase in pressure above CPAP level
  2. 9 cmH20
19
Q

how is CPAP/lower pressure level set at 5cmH2O when setting up CPAP?

A

by setting the lower pressure flowmeter to 8lpm

20
Q
  1. how is lower pressure level set at 5 cmH2O when setting up Biphasic?
  2. how is the high pressure level set at 8-9 cmH2O when setting up Biphasic?
  3. what is the upper pressure Ti set at?
  4. what is the rate set between? what rate is most effective?
  5. what numbers should CPAP stay between? what numbers should PIP stay between?
A
  1. by setting the lower pressure flowmeter to 8 lpm
  2. by setting higher pressure flowmeter to 3-4 lpm
  3. normally 1.0s
  4. between 10-30, rate of 20 most effective
  5. CPAP = 5-6 cmH2O, PIP = 8-9 cmH2O
21
Q
  1. what is the first step in applying CPAP therapy to an infant?
  2. what if you are stuck between 2 sizes?
  3. what is the second step when setting up CPAP?
  4. what is recommended regarding the different interfaces?
A
  1. choosing the right size bonnet?
  2. always go the size smaller as this typically fits better
  3. choosing the right size nasal prongs or mask
  4. alternate between face mask and prongs to avoid tissue breakdown
22
Q
  1. what is the purpose of both the cannulaide and the neoseal?
A
  1. used with CPAP nasal prongs to provide a better seal and prevent nasal breakdown
23
Q
  1. CPAP/NIPPV can be performed through what type of machinery? with the use of what?
  2. can you list 5 of the vents in our lecture that can provide NIV?
  3. what are the 4 different modes that can provide NIV through a ventilator?
A
  1. ventilator and circuit with the use of nasal prongs or mask
  2. VN 500, Servo i/U/N and the avea
  3. NIV CPAP, NIV PSV, NIV PCV, NIV CMV
24
Q
  1. how does the Servo i function to provide NIV CPAP?

2. what is not set on the vent?

A
  1. delivers flow to maintain the preset pressure

2. NO back up rate is set

25
Q
  1. NIV PC on the Servo i also uses what mode?
  2. how is CPAP pressure maintained?
  3. how does NIV PC function on the Servo i?
  4. what does the patient have the ability to do with this mode?
  5. why must the patient be larger than 3 Kg?
  6. what happens if patient breathes above the set rate?
A
  1. assist control mode
  2. by flow
  3. pressure increases at a set RR and inspiratory time similar to PCV
  4. ability of patient to trigger!
  5. vent attempts to synchronize therefore, patient must be big enough for this to occur
  6. vent will try to synchronize with patient effort
26
Q
  1. how does NIV PS function on the Servo i?
  2. what does the patient have control over?
  3. what must be set when using this mode?
  4. why must the patient be greater than 3 Kg?
  5. when would this mode not be the best option?
A
  1. patient initiates a breath and the vent delivers support with the preset pressure level
  2. controls the RR and Vt
  3. apnea ventilation/backup ventilation must be set
  4. vent try’s to synchronize with patient
  5. in the presence of a leak
27
Q
  1. when using the VN 500 for CPAP, what is special about this vent if the neonate becomes apneic?
  2. what else can you do if a patient becomes apneic?
A
  1. hit manual inspiration button

2. can also stimulate the neonate to breathe by flicking the heels or rubbing the back

28
Q
  1. how does the VN 500 function with CMV (NIPPV)?
  2. what can the patient not do in this mode? what else does not occur between the vent and patient?
  3. what are the common settings set? include the ranges (hint: 4)
  4. why is Ti longer with NIPPV? what can happen if Ti is too short
A
  1. vent delivers a set number of breaths to PIP/PEEP with a set Ti
  2. not able to trigger and no synchronization (can use on any patient)
  3. RR 20-40, PIP 12-18, PEEP 6-10, Ti 0.5s
  4. takes longer for pressure to equilibrate and meet the set pressure, if too short then not enough time for circuit to pressurize and deliver to babies lungs
29
Q
  1. what type of NIV can the babylog only provide?

2. what other mode can be provided?

A
  1. NIV CPAP

2. NIV CMV

30
Q

what two modes can the Fabian machine provide?

A

NIV nasal CPAP and DuoPAP (NIPPV-CMV)

31
Q
  1. when setting up the Flexitrunk Interface setup, what should be done first? (hint: 2)
  2. what is the next step? (hint: 2)
  3. when determining what size prongs should be used, what 2 things change about the sizes of the prongs?
A
  1. measuring the infants head circumference and choosing the correct size bonnet
  2. slip bonnet on infants head completely covering the ears and base of neck, front should sit above the eyebrows and use size guide to choose the correct size mask or prongs
  3. the size of the circle (nostril diameter) gets larger and the distance between the prongs changes
32
Q
  1. what is the third step in setting up the Flexitrunk Interface? what should be done after this?
  2. what are the 3 different sizes for the length of tubing? aka what length is used for preemies? middle? term?
A
  1. choosing the correct length of tubing then, connect the prongs or mask to the tubing
  2. 50 mm = preemies, 75 mm = middle, 100 mm = term
33
Q
  1. how far should the prongs stick out of the nares? why? what could be considered to achieve a good seal?
  2. how should the mask sit appropriately on the infants face?
A
  1. place prongs in nares and ensure they sit out 2 mm to avoid pressure on septum, consider the sue of a cannulaide
  2. around the nose, not sit over the lip or cover the eyes
34
Q
  1. how is the nasal tubing secured with the use of CPAP?
  2. where are the clips hooked?
  3. what do you want to make sure you use the least amount of?
A
  1. secured to the hat with the velcro strap
  2. hook clips from side strap to glider
  3. least amount of pressure to maintain an adequate seal
35
Q

how do you monitor a patient on NIV/CPAP? (hint: 8)

A
  • RR/Vitals: WOB, presence/absence of retractions
  • behaviour: irritability or calm?
  • skin condition around the prongs or mask
  • prongs clear of secretions and not blocked
  • assess need for a chin strap
  • suction when needed
  • using OG vs NG tube when possible
  • monitor the pressure levels
36
Q
  1. if on NIPPV, what do we continue to wean until the infant is on CPAP?
  2. how do we wean a neonate off CPAP? (hint: 3)
  3. how long do premature infants normally stay on CPAP for? why?
A
  1. wean the pressure and rate until on CPAP
  2. keep on CPAP until FiO2 decreases below a set number (ex./ 25%) then wean the pressure, then try infant off of CPAP
  3. until at least 32 weeks to allow their lungs to grow
37
Q
  1. what 3 pieces of equipment can provide HFNC?
  2. what is different about the CPAP level in HFNC?
  3. what does the CPAP level depend on?
  4. what are the benefits of HFNC? (hint: 4)
A
  1. optiflow, vapotherm and airvo
  2. CPAP at unknown level (typically lower than normal CPAP level)
  3. depends on: size of infant, prong occlusion, mouth opening and flow used
  4. better tolerated than NCPAP as minimal pt interface required, washes out anatomical dead space, provides optimal humidity and effective oxygen delivery
38
Q
  1. with the optiflow, at what pressure does the pressure manifold go off?
  2. how can you tell the difference if HFNC or CPAP is being used? (hint: think of the pressure blow off)
A
  1. 40 cmH2O

2. CPAP = pressure blow off is white, HFNC = pressure blow off is blue

39
Q
  1. what are the flow ranges from XS-XL with the optiflow?
  2. what are the flow ranges from L-XL with the airvo?
  3. which device uses the MR 850 humidifier?
A
  1. XS = 0.5-8 lpm, S = 0.5-9 lpm, M = 0.5-10 lpm, L = 0.5-23 lpm, XL = 0.5-25 lpm
  2. L = 2-20 lpm, XL = 2.25 lpm
  3. the optiflow!
40
Q

today, what can neonatal nasal NIV be used for?

(hint: 9)

A
  • prevents intubation
  • INSURE protocol
  • surf and turf
  • early extubation to CPAP/NIPPV (even from HFV)
  • prevents reintubations
  • decreases VILI
  • decreased BPD severity
  • NIV NAVA
  • NIV high frequency ventilation

RESP 5017 (19 decks)

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