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CVR > Adjuncts > Flashcards

Adjuncts Flashcards

1
Q

What’s is the effect of NIV?

A

Non-invasive positive pressure ventilation

Used to correct respiratory failure I and II

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2
Q

What is the effect of CPAP?

A

Continuous positive airway pressure
Type of NIV
Used with oxygen to correct hypoxaemja (type I respiratory failure)

  • assistance on expiration only
  • spontaneously breathing patients
  • pressure rather than volume controlled

EPAP/PEEP splints open floppy airways
Recruits collateral channels of ventilation
Increases FRC
Improves gas exchange

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3
Q

Effects of IPPB?

A

Positive pressure delivered during inspiration
Used in type 1 respiratory failure

  • intermittent
  • assistance on inspiration only
  • can use facemask or mouthpiece
AIM- 
Recruits lung volume 
Decrease WOB 
Raises tidal volume 
Opens up collapsed alveoli via collateral ventilation 
Reaches higher pressures than CPAP
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4
Q

Effects PEP?

A

Positive expiratory pressure

Patient breathes out against a flow to produce positive airway pressure

Promotes airflow past obstruction/recruits collateral ventilation channels

The positive pressure encourages airway splinting to prevent premature airway collapse during expiration

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5
Q

Indications of NIV?

A
  • obstructive sleep apnoea (OSA)
  • acute respiratory failure (acute on chronic)
  • Nocturnal hypoventilation
  • Kyphoscoliosis
  • Hypoventilation
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6
Q

Indications of CPAP?

A
  • OSA
  • Acute type I respiratory failure
  • weaning
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7
Q

Indications for IPPB?

A
  • used in spontaneously breathing patients
  • Type 1 respiratory failure
  • In patients that are weak, drowsy, or exhausted and have may;
  • reduced lung volumes
  • increased WOB
  • Atelectasis
  • Sputum retention
  • Neuromuscular disorders who require assisted inhalation
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8
Q

Indications for PEP?

A
  • retained secretions
  • Atelectasis
  • AECOPD
  • Non-CF bronchiectasis
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9
Q

Contraindications to NIV?

A
  • undrained pneumothorax
  • severe hypotension
  • recent upper GI/thoracic surgery
  • cardiac arrhythmias
  • Bullous disease
  • Epistaxis (haemorrhage from nasal cavity)
  • Nasal surgery
  • Risk of aspiration-NG tube
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10
Q

Contraindications to CPAP?

A
  • undrained pneumothorax
  • Haemoptysis of unknown origin
  • Proximal bronchial tumours
  • severe hypotension
  • Emphysematous bullae
  • Lung abscess
  • Active TB
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11
Q

Contraindications to IPPB?

A
  • Undrained pneumothorax
  • Haemoptysis of unknown cause
  • Large bullae
  • Large airway carcinoma
  • Active/untreated TB
  • subcutaneous emphysema
  • facial trauma (inc surgery, fractures)

Precautions

  • uncontrolled pain
  • nausea
  • increased intracranial pressure
  • unstable cardiovascular status
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12
Q

Contraindications to PEP?

A
  • undrained pneumothorax
  • post lung lobectomy/ transplantation
  • severe cardiovascular disease
  • undrained empyema/ lung abscess
  • active haemoptysis
  • inability to tolerant due to increased WOB
  • facial fractures/surgery
  • middle ear infection- increased pressure
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13
Q

Suggested application to CPAP?

A

5cmH2O- 7.5-10-12.5cmH2O

Alternate increasing PEEP/ FiO2

Remove for airway clearance (risk v benefit)

Time with another treatment e.g. IPPB

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14
Q

Suggest application of IPPB?

A

15-20 minutes

Initial pressure of 10-15cmH2O

I:E ratio. 1:3 to 1:4

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15
Q

Suggested application of PEP?

A

Individual required to perform controlled expiration against the resistance, aiming at maintaining expiratory pressure at the mouth of 15cmH2O

Checked by inserted a manometer into the circuit

Repeated for 6-12 breaths

Follow FET

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16
Q

The effect of oscillating PEP?

A

Offer the combination of PEP with high frequency oscillations within the airways during expiration to facilitate secretions clearance

The expiration resistance is intermittent which induces vibrations within the airway wall to displace secretions

17
Q

The effect of RMT?

A

Respiratory muscle training
Weakness of the respiratory muscles= reduction is muscle contractility causing an inability to generate normal levels of pressure and air flow during breathing

Targeting the inspiratory muscles lead to decreased dyspnoea

Improve strength and endurance of diaphragm- tolerant greater inspiratory loads

18
Q

The effect of IS?

A

Incentive spirometry

Activated by patient’s inspiratory effort

A slow, deep inspiration performed with lips sealed around the mouthpiece

Visual feedback- a ball rising to a pre-set marker

Tri-flow

19
Q

The effect of CA?

A

Cough assist

Uses positive pressure to deliver a maximal lung inhalation followed by a switch to negative pressure to the upper airways

Simulating airflow changes during a cough- assisting sputum clearance

20
Q

Devices of oscillating PEP available?

A
  • flutter
  • acapella
  • RC- cornet
  • Shaker
21
Q

Categories of RMT?

A

Strength

External load device
3 Main categories

  • passive flow-resistance
  • dynamically adjusted flow- resistance
  • pressure threshold valve
22
Q

Indications for oscillating PEP?

A
  • CF
  • Non-CF bronchiectasis
  • severe COPD
  • retained secretions
  • atelectasis
23
Q

Indications for RMT?

A
  • chronic respiratory disease e.g. COPD, CF
  • dyspnoea/ exercise tolerance
  • surgical patients
24
Q

Indications for IS?

A

Post- surgery- upper abdominal

25
Q

Indications for cough assist?

A
  • sputum
  • respiratory muscle weakness
  • weak cough
  • neuromuscular disease
26
Q

Contraindications for oscillating PEP?

A
  • undrained pneumothorax
  • post lung lobectomy/transplantation
  • severe cardiovascular disease
  • undrained empyema/ lung abscess
  • active haemoptysis
  • sinusitis
  • inability to tolerant due to increased WOB
  • facial fractures/surgery
  • middle ear- infection- increased pressure
27
Q

Contraindications to RMT?

A

Caution should be exercised

  • history of spontaneous pneumothorax
  • unhealed pnemothorax
  • burst eardrum/condition of the eardrum

Patients with unstable asthma and abnormally low perception of dyspnoea

28
Q

Contraindications to CA?

A
  • undrained pneumothorax
  • uncontrolled asthma or bronchospasm
  • hypotensive
  • haemoptysis
29
Q

Suggested application of oscillating PEP?

A

Cycle of breathing repeated for 5-15 breathes depending on volume of secretions and levels of fatigue and dyspnoea

30
Q

Causes of Respiratory muscle weakness?

A

Respiratory diseases

  • hyperinflation
  • increased WOB
  • Hypoxaemia
  • hypercapnia

Reduced inspiratory muscle strength

  • steroid induced myopathy
  • chronic inflammation

Neurological lesions
Intense weight loss
Metabolic disturbances e.g. exercise, fever, acidosis, anaemia

31
Q

Suggested application for IS?

A

Can be used during thoracic expansion exercises

Nice, slow breath in and hold
Inspiration for 2-3 seconds

32
Q

Suggest application for CA?

A

Expiratory flows greater than 160l/m

Incorporate rest periods

CVR (8 decks)

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