Assisted Ventilation in Acute Respiratory Failure

Question 1

Assisted ventilation can maintain a tidal volume via

Answer 1

IPPB (intermittent positive pressure breathing)
or
BIPAP (inspiratory positive airway pressure)

Question 2

Assisted ventilation can increase FRC via

Answer 2

CPAP (continuous positive airway pressure)
or
BIPAP (expiratory positive airway pressure)

Question 3

Assisted ventilation can reduce the work of breathing by supporting inspiration via

Answer 3

IPPB (intermittent positive pressure breathing)
OR
BIPAP (inspiratory positive airway pressure)

Question 4

Assisted ventilation can support failing respiratory muscles and ventilation at the same time via

Answer 4

BIPAP (bilevel positive airway pressure)

Question 5

What is PEEP?

Answer 5

Positive end expiratory pressure

Question 6

So what can BiPAP do? (bilevel positive airway pressure)

Answer 6

1) Maintain a tidal volume (IPAP)
2) Increase FRC (EPAP)
3) Reduce the work of breathing by supporting inspiration
4) Support failing respiratory muscles and ventilation at the same time

Question 7

CPAP (continuous positive airway pressure) increases

Answer 7

functional residual capacity

note: no change in tidal volume

Question 8

IPPB (intermittent positive pressure breathing) is _______ cycled

Answer 8

pressure cycled

Question 9

What is intermittent positive pressure breathing (IPPB)

Answer 9

Simple assisted inspiration with a pressure cycled ventilator

Question 10

Whats a key difference between IPPB and CPAP?

Answer 10

IPPB does not splint airways open at end of expiration like CPAP

Question 11

Whats the advantages of Non-Invasive Ventilation in Acute Respiratory Failure?

Answer 11

• You avoid the complications of intubation
• You reduce the need for sedation
• Improve patient comfort
• Maintain airway defence, speech and swallowing

Question 12

Contraindications and limitations to MASK ventilation?

Answer 12

• Unco-operative or unmotivated patients
• Pts at high risk of aspiration
• Inability to effectively clear secretions
• Haemodynamic instability
• Unstable multiple organ failure
• Inability to fit an acceptable mask

Question 13

Criteria for selecting patients for assisted or mechanical ventilation

Answer 13

• Extremely low RR
• Obvious respiratory muscle fatigue
• Severe respiratory distress
• Profound hypoxaemia
• Depressed mental state, coma or confusion
• Impending cardiopulmonary collapse
• Other evidence from ABG’s and CXR

Note: not all patients requiring mechanical ventilation have respiratory problems