CPAP and NPPV

Question 1

What is CPAP?

Answer 1

A Constant pressure applied to the spontaneously breathing patient.

Question 2

CPAP is applied via what?

Answer 2

A mask-type device.

Question 3

CPAP does not do what?

Answer 3

It does not provide volume change or support in the patient’s minute ventilation.

Question 4

What are some indications for CPAP?

Answer 4

It helps treat obstructive sleep apnea (OSA), it improves oxygenation.

Question 5

What does NPPV stand for and what does it do?

Answer 5

NPPV stands for: Noninvasive Positive Pressure Ventilation. Pressure is applied intermittently with inspiration having a higher pressure than expiration.

Question 6

What are the indications for NPPV?

Answer 6

Acute respiratory failure, Chronic respiratory failure

restrictive lung disease, neuromuscular disease, nocturnal hypoventilation

Question 7

NPPV avoids trauma associated with what?

Answer 7

Intubation, and the complications associated with artificial airways.

Question 8

What does NPPV reduce the risk of?

Answer 8

VAP, ventilator-associated pneumonia.

Question 9

What are some contraindications of NIV?

Answer 9

Respiratory arrest (apnea) or the need for immediate intubation,
unable to protect the airway,
excessive secretions, hemodynamic instability, agitated and confused patients,
paradoxical breathing, upper airway obstruction.

Question 10

What are some advantages of nasal masks?

Answer 10

Less risk of aspiration, 
enhanced secretion clearance, 
less claustrophobia, 
easier speech, and 
less dead space.

Question 11

What are some disadvantages of the nasal mask?

Answer 11

Mouth leak,
less effectiveness with nasal obstruction,
nasal irritation and rhinorrhea, and
mouth dryness.

Question 12

What are some disadvantages of a full face mask?

Answer 12

Increased dead space, difficulty in maintaining a seal, increased risk of pressure sores, claustrophobia, increased aspiration risk, difficulty with speech, inability to eat with the mask on, difficulty with secretion clearance, and possible asphyxiation.

Question 13

What are the vented masks for?

Answer 13

They require a vent for exhalation and use only one corrugated tube to connect to the ventilator.

Question 14

What is the typical IPAP setting?

Answer 14

It is typically 8 – 12 cmH2O. It can be adjusted to change the tidal volume.

Question 15

What is the typical EPAP setting?

Answer 15

It is usually started out at 4 cmH2O and can be increased in order to improve oxygenation.

Question 16

What does the rise time do?

Answer 16

It determines how fast the vent rises from baseline pressure to target pressure.

Question 17

The high and low-pressure alarm must be set to what in ST mode?

Answer 17

It should be set at +/- 5 in ST mode.

Question 18

The low minute ventilation is usually set at what?

Answer 18

10-20% below patient’s baseline.

Question 19

When will the apnea alarm sound?

Answer 19

When it does not recognize a spontaneous breath.

Question 20

What are the 9 goals of NIV in the acute care setting?

Answer 20

Improve gas exchange,
avoid intubation,
decrease mortality,
decrease the length of time on the ventilator,
decrease the length of hospital stay,
decrease the chance of ventilator associated pneumonia,
relieve respiratory distress symptoms,
improve patient-ventilator sycnhrony, and
maximize patient comfort.

Question 21

3 main goals of NPPV:

Answer 21

Avoid of intubation and invasive ventilation
Relieve dyspnea and upper airway obstruction
Enhance the gas exchange

Question 22

What therapy should be tried first for a patient who has pulmonary edema from left heart failure?

Answer 22

CPAP

Question 23

Which NIV settings are adequate for a pt with cardiogenic pulmonary edema?

Answer 23

Mask CPAP at 8 – 12 cm H2Ocm and 100% FiO2.

Question 24

What are some benefits of CPAP in postop abdominal surgery?

Answer 24

It lowers the chances of intubation, pneumonia, and infection/sepsis rates.

Question 25

Which groups of patients are considered at risk for reintubation?

Answer 25

COPD, CHF, hypercapnia.

Question 26

Which restrictive thoracic diseases are successfully managed with NIV?

Answer 26

(1) Post-polio syndrome, (2) Chest wall deformities, (3) Neuromuscular diseases, (4) Spinal cord injuries, and (5) Severe kyphoscoliosis.

Question 27

How does NIV benefit patients with restrictive thoracic diseases?

Answer 27

It helps to rest inspiratory muscles, it helps by lowering CO2, and it improves the patient’s compliance, FRC, and deadspace.

Question 28

What are the required alarms for NIV?

Answer 28

Battery failure, circuit disconnect, and loss of power.

Question 29

What strategy should be used when the patient complains of nasal congestion during the use of a nasal mask for NIV?

Answer 29

Add a heated humidifier.

Question 30

Which is the current recommendation for adding humidity while using NIV?

Answer 30

Recommend it for long-term patients (longer than a day).

Question 31

What defines the successful application of NIV?

Answer 31

Imporved ABGs: Paco2 decrease, pH increase and PaO2 increase.
increase work of breathing, increase SpO2 %
Clinical improvement: decreased Respiratory Rate, increase Vt, diminished accessory muscle use (decrease work of breathing)

Question 32

What physiologic effect does raising the EPAP (PEEP) have on a patient receiving NIV?

Answer 32

An increased in FRC.