Ch 6: Noninvasive Mechanical Ventilation

Question 1

NPPV vs Ventilators

Answer 1

• NPPV cannot generate higher pressures.
• NPPV single limb w exhalation valve near mask.
• NPPV monitors and compensates for leak.

Question 2

Modes of NPPV

Answer 2

CPAP:

• No trigger, limit or cycle.
• Continuous positive pressure.
• Do not use if apnea risk!!

BiPAP

• Trigger is pt. inspiration
• Limit is the Inspiratory pressure or time (3s)
• Trigger is reaching the IPAP
• Then switches to Expiratory pressure.
• Can set a backup rate of pt. RR to low.
• Analogous to CPAP w Pressure Support on inspiration.

High Flow Nasal Canula

• Constant flow rate adds some PEEP up to 8cm H2O

Question 3

Indications & ContraIndications

for NPPV

Answer 3

Indications:

• Conscious and cooperative
• Patent and stable airway
• Preserved ventilatory drive
• Disease that will improve quickly
  
  • COPD Exacerbation
  • Moderate to severe status asthmaticus
  • Pulmonary Edema

Contraindications:

• Threatended airway
• Apnea
• Uncooperative

Question 4

Initiating NMV

(Noninvasive Mechanical Ventilation)

Answer 4

• Begin CPAP at 3 to 5
• Allow patient to hold the mask on
• When tolerated place straps
• Increase by 2cm every 5 to 10 minutes
• Bipap start at 8 and 3.
• IPAP must always be 5cm or more greater than EPAP
• Can step IPAP/EPAP in tandem 2cm every 10 min.
• Or if respiratory acidosis mainly IPAP.
• Cannot measure autoPEEP in COPD so EPAP should

usually be kept under 8cm H2O.

IF NOT meeting comfort, WOB, oxygen and CO2 goals within 1 hour may requiring Mechanical Ventilation.

Question 5

Monitoring NMV

Answer 5

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