Adjuncts Flashcards
What is Non invasive ventilation?
A technique where positive pressure is applied to airways without a tube to provide ventilatory assistance.
NIV benefits
Improves oxygenation, lung volumes, enhances airway clearance and manages respiratory failure.
NIV devices
Nasal masks, full facemasks, nasal pillows and tracheostomy
NIV indications
Type 2 respiratory failure, nocturnal hypoventilation, acute exacerbations of COPD, weaning
What is CPAP?
Continuous positive airway pressure
It splints open floppy airways and recruits collateral ventilation channels
It is a type of NIV used with oxygen to treat type 1 respiratory failure
CPAP benefits
Improves V/Q
Maintains FRC
CPAP devices
Hood and mask
Nasal
Nasopharyngeal
Face mask
CPAP indications
Type 1 respiratory failure
Weaning
Increased WOB
Reduced lung volumes
What is IPPB
Intermittent positive pressure breathing
Assists with inspiration
Delivers 40% oxygen
Can use with TEE
IPPB benefits
Helps clear sputum, improves oxygenation, increases lung volumes, decreases work of breathing
IPPB indications
Type 1 respiratory failure Lots of secretions unable to clear Need to improve lung expansion Reduced lung volumes Increased WOB Treatment of atelectasis
IPPB application
1-2 H20 sensitivity
10-15cmH20 initial pressure
What is PEP
Positive expiratory pressure
It is breathing out against a resistance
The positive pressure splints airways to stabilize peripheral airways and prevent them from collapsing.
Gets air behind mucus via collateral ventilation channels and forces secretions to larger airways for expectoration
PEP indications
Retained secretions
Atelectasis
Non CF-bronchiectasis
Acute exacerbation of COPD
PEP application
Seated Inspire slightly greater than tidal Exhale for 3 seconds 10-20cmH20 6-12 breaths Followed by FET and coughing 6-12 cycles
What is oscillating PEP
Combination of PEP and high frequency oscillations
Oscillating PEP devices
Flutter
Acapella
RC-cornet
Oscillating PEP indications
Retained secretions
Atelectasis
COPD
Non CF-Bronchiectasis
What is the flutter device?
Encases a high density ball which rolls up and down to interrupt expiratory flow and generate positive expiratory pressure
Generates oscillatory vibrations to shear secretions from airways
Flutter application
Upright position Slow deep inspiration Breath hold 2-3 seconds Expire slightly faster than normal Repeat 5-15 times Followed by FET and coughing
RC-Cornet application
Upright position Slow deep inspiration Breath hold 2-3 seconds Slightly active expiration Repeat 8-10 times Followed by FET and coughing
Acapella application
Inspire with short breath hold
More active expiration
Followed by FET and coughing
Can use in any position
What is respiratory muscle training
Improves strength and endurance of diaphragm
Tolerate greater inspiratory loads to prolong exercise tolerance and reduce dyspnoea
What is weakness of respiratory muscles?
A reduction in contractility causing inability to generate normal levels of pressure and airflow during breathing.
RMT devices
Passive flow resistance
Dynamically adjusted flow resistance
Pressure threshold valve
RMT indications
COPD
Dyspnoea
Exercise intolerance
Surgical patients
When is IMT most useful?
When added to whole body exercise training
What is incentive spirometry?
Device activated b patient’s inspiratory effort
Can be used during TEE
IS devices
Incentive spirometer
Tri-flow
IS indications
Surgical patients
Prevent post op complications
Reduced lung volumes
IS application
Slow deep breath in
Avoid quick inspiration
Recommend to patient they use it in their own time, e.g. every time the nurse walks past.
Tends to be used in surgical patients and may be useful for children.
What is cough assist?
Uses positive pressure to deliver maximum lung inhalation
Then abruptly switches to negative pressure in upper airway
This rapid change stimulates airflow changes that occur during a cough
Cough assist devices
Mechanical insufflator/exsufflator
Cough assist indications
Respiratory muscle weakness
Weak cough
Neuromuscular disease
Retained secretions
What is the risk with cough assist?
There is a risk of mobilizing large mucus plugs into central airways which can obstruct airways
Cough assist application
Produces expiratory flows of greater than 160 L/M
Incorporate rest periods
Start pressures low to allow patient to acclimatise
