BIPAP vision Flashcards
Can BIPAP be used invasively?
NO
IS BIPAP a life support?
NO
what interfaces can bipap used with?
1) a single limb, open circuit with intentional leak on patient face mask
2) used for non-life supported invasive ventilation if properly equipped
Does BIPAP have a backup battery for system?
NO
What is the Rechargeable battery for?
the operation of the alarm
What is the pnuematic source of BIPAP
- High pressure Oxygen
- ->it can function without O2
- blower
- ->draws ambient air in
What control the output flows in BIPAP
PVA (pressure valve assembly)regulates system flow and pressure
What is the air flow through the BIPAP pneumatic system?
ambient air–>filter–>blower–>PVA(pressure valve assembly) –> pass through the exhaust –>AFM (airflow sensor) –> patient circuit
What are the controlled pressure valve in BIPAP?
1 controls IPAP
1 acts as exhaust to maintain EPAP
How is pressure maintained?
Based on IPAP and EPAP settings
–> control circuit adjusts the electrical current in the pressure valve coil
–>The electrical current, in combination with a magnetic field, produces a force on the valve disc
–> this force produced must equal the force created by the air pressure to maintain a stable pressure
How does PVA adjust the pressure?
by controlling the amount of flow going to the patient via the exhaust
What is the exhaust function?
fxn similar to a exhalation valve
What is the AFM (air flow module)
detect the pressure and flow from the proximal pressure line, which signals the exhaust and blower to initial its adjustment
how does the blower adjust the fow
by varying its speed
Where is the proximal line enter to the system?
flow of gas entering before the AFM
how to add supplementary flow in BIPAP
- add flow a mask port (up to 15 lpm
2. add flow at machine outlet
What function is needed to be activated after adding supplementary flow
LEARN BASE FLOW
What are the total leaks of the BIPAP
fixed leak + unintentional leak
What are the total flow consisted in in BIPAP?
total flow = estimated flow (going into the patient) + (unintentional + fixed) leak
what is the fxn of Exhalation Port Test
Measures intentional leak from exhalation port
What is the display if Exhalation Port Test isnt done
tot leak
What is the display if Exhalation Port Test is done
Pt leak
when to perform exhalation port test? and why
when mask is changed
because it measures the fixed leak of the new mask to calculate baseline leak
What is the function of Auto-Trak Sensitivity
recognize and compensate for unintentional leaks
How does the Auto-Trak Sensitivity work
adjust its trigger and cycle based on Tidal Volume or Expiratory Flow rate
How does the Auto-Trak Sensitivity use expiratory flowrate ?
1) it measures the baseline flow 5 sec after the start of cycling
2) if the flow is above the baseline flow ( which is 0), it assumes unintentional leak
3) it d then adjust the flow by comparing the current leak and previous leak flow
Why does the VT relate to the leak
1) Unit assumes volume into the pt. = volume out of pt.
2) If the volume out is greater, assumes the extra volume is unintentional insp leak volume.
3) Volume will be adjusted based on the calculation
If more volume results in increase baseline leak –> the new volume given will be less
What is the trigger of BIPAP
Volume
- 6cc inspired volume accumulates above baseline flow, trigger by patient
Shadow/shape signal
- when the shadow waveform meet the actual waveform
how does the Shape Signal
work?
follows” the flow pattern, at 15 lpm less flow, 400msec “behind” the pt. flow
- helps with triggering and cycling
What cycles BIPAP
- Shape Signal (same as triggering)
- Spontaneous Expiratory Threshold (SET)
- Flow reversal
- Time back up
how does the SET work
Electronic signal that rises in proportion to the inspiratory flow rate on each breath
- signal will rise until it intersects with the inspiration, then cycle
how does flow Reversal work
- Cycles out of IPAP if large leak occurs
2. while the flow is decelerating, it then accelerates in response to a large leak
What is the I time backup for cycling
3 sec
What are the mode of BIPAP
• CPAP (spontaneous)
• PSV (IPAP/EPAP)
• Spontaneous/timed (S/T)
- PAV/T
What is the setting for CPAP mode
CPAP,
FiO2
RATe
What is the setting for S/T mode
IPAP, EPAP, Rate I time rise time FiO2
When does S/T switch to time mode
when spont RR drops below set rate, vision deliver PC breath (set IPAP and I TIME)
how to tell if the time mode is activated
‘V’ appears on VT waveform
how does the PAV/T work
Delivers pressure in proportion to effort
settings of PAV/T
- % set,
- Maximum Volume Assist,
- Maximum Flow Assist
If patient fails to trigger the breath –> becomes a time breath
- Back up rate and other parameters (IPAP, EPAP, I time, rise time)
When does the exh port alarm go off
baseline flow is < 5 L/min or 50% of intentional leak for one minute
when does the Hi P go off
Proximal pressure > setting for > 0.5 second
when does the low pr go off?
Proximal pressure below criteria for duration of Low pressure delay
What is low pressure delay
the maximum amount of time allowed for proximal pressure to be lower than the set Low P
when is learn base flow activated?
- After changing circuit
- After adding flow to the circuit
what are the precaution when using BIPAP
1 . Pt. must be able to support their ventilation and protect their airway
- DO NOT use a HME–interferes with flow sensing capabilities