Exam 1 CPAP/MV Flashcards
what are the indications for the use of CPAP
- obstructive and restrictive lung disease
- atelectasis
- lung fluid retention
- respiratory distress syndrome
- to eliminate or reduce need for prolonged ventilator support
- premature infants
- pneumonia
- TTN
- MAS
what does the AARC CPG say about CPAP
- RR > 30% normal (30-60)
- paradoxical chest movement
- supra/substernal retractions
- grunting
- nasal flaring
- cyanosis
- exhibits adequate ventilation
what are conditions in which CPAP should be considered
- slow progression of RDS
- enhance surfactant production
- improve lung function in postoperative congenital heart disease
- diaphragmatic hernia
5.
what are the complications fo CPAP
- air leaks
- increased intracranial pressure (ICP) - overdistention
- renal insufficiency (decreased urine output)
- bowel distention
- desaturation (due to leaks)
- obstruction
- local irritation and trauma - nasal septum
- pulmonary overdistention
- CO2 retention
- air leaks around application
- skin/nasal irritation
- increased WOB
what are the initial settings for CPAP
- initial pressure 4-6 cmH2O (4-5)
- in no improvement increase pressure by 1-2 until a max 10 cmH2O
- if positive response is noted FiO2 < 60% and PaO2 at least 50 mmHg
how is CPAP weaned
- lowest FiO2 possible
- wean by 1-2 cmH2O
- wean to a level of 3-5 cmH2O
FiO2 first then pressures
what are contraindications for the administration of CPAP
- consistent PaCO2 > 60 torr
- pH < 7.25
- severe upper airway abnormalities
- untreated congenital diaphragmatic hernia
- CNS depressant medications
- central or frequent apnea
- hemodynamic instability
- poor respiratory drive
when should CPAP weaning occur
- patient is stable
- has no apneic episodes/periods
- stable VS
- acceptable ABG and CXR
describe bubble CPAP and how it works
- a measuring tape is attached to the outside of the water column
- the CPAP level is maintained by submerging the distal end of the expiratory circuit straight down into the fluid from the surface of the water line to a measured depth in centimeters, thus creating the amount of CPAP in centimeters of water
- if a higher level of CPAP is needed, the tube can be advanced farther down into the fluid column
why is the minimal flow rate to a B-CPAP (bubble CPAP) necessary
the flow rate of humidified gas (6 to10 L/min) is set to meet the inspiratory flow rate requirements of the patient, maintain the CPAP level, and rinse the system of exhaled carbon dioxide
what types of complications may the infant exhibit with an elevated pressure application with CPAP
an increased MAP can result in increased alveolar dead space because of mechanical compression of the pulmonary microvasculature
how is the pressure measured in the CPAP systems
at the site of airway
how should the interface device be applied
what are indications for MV
- to manipulate alveolar ventilation
- to improve oxygenation
- to optimize lung volume
- to reduce WOB
- to minimize risks associated with ventilator-induced lung injury
- severe oxygen deficit
- respiratory failure with CO2 and significant respiratory acidosis
- inadequate or absent respiratory effort
- excessive WOB
- high oxygen demand
- severe respiratory acidosis
- mod to severe respiratory distress
- postoperative period
what are complications of MV
- volutrauma, atelectrauma, barotrauma (VILI)
- cardiovascular complications (decreased C.O.)
- hyperoxia
- hypoventilation
- pneumothorax
- pneumonia
- abdominal distention
- mechanical failure
- airway complications
what are contraindications of MV
in VC ventilation what affects pressures (PIP, Pplat, Raw)
- pulmonary compliance
- pulmonary resistance
- RR
- PEEP
- FiO2
how is volume affected in high system pressures during VC ventilation (what are underlying causes)
decreased volumes due to compliance of lung decreasing
in PC ventilation what affects volumes
- PIP
- inspiratory time
- RR
- flow
- FiO2
- PEEP
how do you calculate tidal volumes for neonate
5-8 mL/kg
grams / 1000 = kg
how does MV weaning occur
ideally after significant resolution or reversal of the pathologic condition for which MV was initiated
when should MV weaning occur
- patient stable
- receiving adequate nutrition
- able to breath spontaneously
- maintain clinically acceptable PaCO2
- PEEP < 8
- PIP < 30
- rate < 20
- FiO2 < 0.4 or 0.5
what is respiratory failure in a neonate
PaO2 < 50 mmHg
PaCO2 > 45-55
how is ventilation improved with MV
- increasing frequency
- increasing I-time
- increasing flow
- increasing PIP (PCV)
how is oxygenation improved with MV
- FiO2
- MAP
- PEEP
- inspiratory time and I:E
- flow rate
how is a neonate weaned from MV
- PEEP < 8
- PIP < 30
- Rate < 20
- FiO2 < 0.4 or 0.5
what are causes of ventilator dysynchrony
- wrong ventilator mode
- infant effort
- inadequate flow rates
- airtrapping
- terminating inspiration before desire to exhale
what results from inadequate flows, Ti, Te
possible pneumo by damaging lung, not lung protective
how are leaks addressed
- > 15% of delivered tidal volume
2. usually reintubation is necessary
what are settings for pre-term baby
- weight (ideal kg) < 2
- RR: 30-50
- mandatory VT: 4-6
- mandatory PIP: 18-25
- inspiratory time: 0.25-0.4
- PEEP: 3-5
- FiO2: start 10% higher than preintubation or 1.0
- trigger: 0.25-0.50
- pressure support: minimum level: 6-10
- PS threshold: 10-25% of PIP
what are settings for term baby
- weight (ideal kg): 2-10
- RR: 25-40
- mandatory VT: 5-6
- mandatory PIP: 18-25
- inspiratory time: 0.4-0.5
- PEEP: 5-7
- FiO2: start 10% higher than preintubation or 1.0
- trigger: 0.25-0.50
- pressure support: minimum level: 6-10
- PS threshold: 10-25% of PIP
what are the most serious complications of MV
- volutrauma, atelectrauma, barotrauma (VILI)
- cardiovascular complications (decreased C.O.)
- hyperoxia
- hypoventilation
- pneumothorax
- pneumonia
- abdominal distention
- mechanical failure
- airway complications
what is the goal of MV
- provide adequate ventilation (PaCO2 45-55, pH >7.25<7.45)
- provide adequate oxygenation (PaO2 50-70, SpO2 >88 to 92 preterm, 90-95 term)
- promote patient/ventilator synchrony
- recruit and maintain lung volume
- safety
- comfort
- liberation
