CPAP - PCP Flashcards
Continuous Positive Airway Pressure (CPAP) - PCP
CPAP is a non-invasive means of increasing oxygenation in patients who are in significant respiratory distress and require more than supplemental oxygen, but are not at the point of invasive airway management.
The application of an airtight face mask w/ continuous pressure to the lungs has been shown in many research studies to reduce intubation requirements and mortality
CPAP devices deliver a controlled amount of positive pressure during both the inspiratory and expiratory phase of the breathing cycle supporting alveolar recruitment and maintenance in an effort to improve pulmonary gas exchange
Indications
Any pts in SIGNIFICANT respiratory distress who meets the following;
- Awake and able to follow commands
- Ability to maintain open airway
- => 13 y/o
- Exhibits all of the following:
>24 RR
< 94% SPO2 on O2
use of accessory muscles
Contraindications
- < 13 y/o
- DLOC - unable to follow commands
- Resp. arrest/hypoventilatio
- Unable to fit mask
- Vomiting - risk of aspiration
- Traumatic cause of resp. distress
- Tracheostomy
- Pneumothorax
- SPB < 90 mmHg
CliniCALL must be called prior to PCP application of CPAP
Recommended Uses
- Consider adult pts w/ significant resp. distress
- CHF / Acute Pulmonary Edema
- Asthma
- Near Drowning
- COPD
- Pneumonia
Special Considerations
CPAP requires..
- an air-tight seal of facemask for optimal performance
- should be discontinued in the case of pt non-tolerance or progression to resp. failure
- should not delay the administration of medications (i.e Nitro)
- Observe pt for signs/symptoms of hypotension or resp. failure
- DNR is NOT considered a contraindication to CPAP use
- COPD/Asthma - start w/ conventional bronchodilatory therapy then determine if CPAP is indicated
- Use extreme caution in any patient w/ history of neuro-degenerative disorder (e.g ALS)
Advantages
- Permits adequate oxygenation w/ lower FiO2
- Avoidance of risk and complications of intubation
- Decreases the risk of hospital acquired infections
- Preservation of normal airway defense mechanisms (gag reflex)
- Reduces length of stay in hospital and mortality compare to ETI
Complications
- Heightened sense of claustrophobia or smothering leading to non-tolerance
- Pt discomfort
- High external pressures may increase intrathoracic pressures thus decreasing venous return and decreasing cardiac output (rare)
- Increased challenge in clearing secretions and suctioning
- Difficult to assess airway patency
Precautions
- Assisted ventilations w/ BVM +/- PEEP is the mainstay of treatment for pts who demonstarte respiratory failure (e.g ALOC, shallow tidal volume, hypoventilation) CPAP not appropriate
- Mechanical ventilation and intubation remain the mainstay of treatment for patient w/ persistent hypoxia or respiratory muscle fatigue. CPAP not appropriate
Procedure for Rescuer CPAP - Preparations
- Demonstrate appropriate body substance isolation procedures
- Assemble and prepare the equipment
- Explain the CPAP procedure to the pt
- Obtain verbal consent for treatment
- Prepare CPAP equipment and oxygen supply
- Place the pt in upright sitting position
- SPO2 monitor on
Procedure for Rescuer CPAP - Applications
- Initiate CPAP at 5lpm w/ PEEP valve set to
- Have pt hold CPAP mask in proper position w/ proper force and coach the pt in order to gain acceptance of the mask. A calm directive approach is key
- Place the head cap/straps if pt will tolerate
- Adjust PEEP valve to 5cm H20
Procedure for Rescuer CPAP - Monitoring
- Monitor the face mask placement for fit and address any leaks
- Monitor the pt’s resp. response to the CPAP
- If SPO2 remains <92% follow manufactures flow/rate CPAP chart and increase flow rate to 8L followed by increasing the PEEP valve to 10cm H2O
- (max CPAP of 10cm H2O for PCPs)
- Monitor the pts tolerance
- Monitor and record complete vital signs every 5 mins
- Continuous reassessment for need to positive pressure ventilate
- Continue w/ medications as appropriate ( Nitro, Ventolin)
Discontinue CPAP if any of the following occur:
- pts mental status deteriorates and they cannot follow commands
- pts respiratory status declines (resp. failure) or they cannot maintain airway
- pt develops active vomiting or active upper GI bleeding
- pt is unable to tolerate the mask
- pts BP drops below 90 systolic
- equipment failure or concerns
Post CPAP Removal
- place on NRFM at high flow O2
- Prepare for BVM assistances
- Prepare for possible endotracheal intubation
Special Notes
- In-line neb may be utilized w/ CPAP in place or MDI may be used
- Most pts will show signs of improvement in 5-10 mins - if pt does not improve assess for other causes. Re-evaluate for intermittent positive pressure ventilation or intubation
Rescuer 2 CPAP Device
Utilizes an oxygen port at the bottom of the device sealed w/ a green cover to drive an in-line neb connected to the device w/ a T -piece. A second oxygen source could also be used
- Oxygen flow rate has to be set @ 7lpm above the manufactures recommended flow rate for the same level of CPAP if in-line nebulizer and T=piece is required
