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Interventions 2 (RESP 319) > Mod 7 Non-invasive > Flashcards

Mod 7 Non-invasive Flashcards

1
Q

What can you use to guide CPAP treatments?

A

CxR (pre and post) mostly as needed.

  • To check for overdistension
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2
Q

How often do you pull a CPAP mask off to change the interface?

  • why?
A

Every 6 hours.

  • swap to prongs to not cause breakdown at the surface level of skin/cause pressure sores.
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3
Q

What are indications for CPAP/SiPAP (5)

A
  1. Respiratory distress (retractions, nasal flaring, grunting)
  2. CxR findings of decreased lung volumes and/or pulmonary infiltrates
  3. Post-extubation mode for all infants<33 weeks corrected gestational age
  4. Apnea of Prematurity
  5. Pulmonary edema (CHF or PDA w/(L->R) shunt)
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4
Q

What are the primary physiological effects of CPAP? (6)

A
  • Increases FRC and Vt
  • Decreases intrapulmonary shunt
  • Increases pulmonary compliance
  • Decreases airway resistance
  • Improved V/Q ratio
  • Decreases WOB and reduces alveolar dead space
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5
Q

How does CPAP affect the upper airways?

A

CPAP stabilizes the chest wall and upper airways.

  • Prevents obstructive apnea
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6
Q

How does CPAP affect the lower airways?

A

Decreases WOB and reduces alveolar dead space (stents alveoli open = more surface area for gas exchange)

  • Better type 2 pneunocyte function and even recycling of surfactant (aids recovery from RDS)
  • Decreases cellular indicators of lung injury
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7
Q

What is a absolute requirement for CPAP

A

Patient needs to have a intact ventilator drive and the ability to move air

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8
Q

What patients can move on from mechanical ventilation to CPAP?

A
  • PaCO2 >60
  • pH <7.25
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9
Q

What are contraindications for CPAP?

A
  • Need for intubation/mech vent.
  • upper airway abnormalities (i.e choanal atresia)
  • Hemodynamically unstable (could arrest)
  • vent. failure
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10
Q

How can CPAP be performed/delivered?

A
  • Mechanical vents
  • Bubble CPAP devices
  • SiPAP (is CPAP via BiPAP mode)
  • High Flow Nasal Prongs (needs a blender to control FiO2)
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11
Q

Why are High Flow Nasal Prongs not the go to for delivering CPAP?

A

High Flow Nasal Prongs don’t really provide CPAP (to its full extent) because they can’t occlude the nose enough.

  • Pressure is highly variable
  • Prongs are < 50% of nares diameter
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12
Q

What should your initial CPAP levels be?

A

4-6, but you shouldn’t wean to 4 if possible (don’t get much out of it)

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13
Q

Bubble CPAP?

A
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14
Q

what is SiPAP?

A

A very effective method of delivering CPAP.

  • is its own specific device
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15
Q

what settings should you initially set and make sure are running when operating a High Flow Nasal Cannula?

A
  • Head and humidified
  • Flow up to 8 LPM
  • FiO2 adjusted w/blender
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16
Q

What should you recognize as a sign that a kid doesn’t need CPAP anymore?

A

Term kids fight the machine (pull the mask/tubes)

  • They might be better left on prongs
  • premies are usually fine
  • Can only tolerate CPAP in intervals (sometimes 1hr at a time)
17
Q

What are things to check if you suspect CPAP failure?

A
  • Baby is not fighting CPAP interface
  • Nasal prongs are correct size
  • Adequate humidity w/o condensation in circuit
  • Adequate pressure and FiO2 delivered (check neck position, clear nostrils and airways)
  • Surfactant has been admin’d in cases of RDS
18
Q

What are markers of CPAP failure?

A
  • Increased WOB, nasal flaring and retractions
  • Decreasing pH <7.25 and PaCO2 > 60
  • Increasing FiO2 needs w/PaO2 < 50-60
  • Nasal CPAP exceeding 8-10 cmH2O
  • Frequent apnea w/cyanosis and bradycardias with no reaction to caffeine therapy.
19
Q

What are indicators of effective CPAP (stabilization)?

A
  • Comfortable infant
  • Reduced RR
  • Minimal or no chest retractions
  • Reduction in severity and frequency of apneic episodes
  • Appropriate blood gas (need to check)
20
Q

How is SiPAP (Synchronized Intermittent Positive Airway Pressure) different from CPAP?

  • Hint synchronization
A

In SiPAP the delivery of positive pressure is synchronized with the patient’s respiratory efforts. (pressure variability)

  • AKA the device senses the patient’s spontaneous breaths and delivers pressure support in sync with their breathing pattern.
  • In contrast, CPAP provides continuous, unchanging levels of pressure
  • More comfortable than CPAP, allows the Pt to spontaneously breath
  • It is suitable for patients who require synchronized support and are not in a condition to initiate breaths entirely on their own.
21
Q

How does BiPAP ventilation deliver PEEP and differ from CPAP

A

Bipap delivers 2 pressures (IPAP and EPAP)

  • IPAP is set at a higher pressure delivered during inhalation to assist with oxygenation and promote effective ventilation
  • EPAP is set at a lower pressure maintained during exhalation to help keep the airways open.
  • used to reduce the work of breathing, improve oxygenation, and support patients in respiratory distress
22
Q

How does Biphasic ventilation deliver PEEP and differ from CPAP

A
23
Q

In your initial assessment:

  1. how would you know if a Pt is ready for weaning from CPAP?
  2. how would you begin weaning?
  3. What does the timeline of weaning look like before d/c?
A
  1. Pt has Low WOB and low Fio2 at current support.
  2. You wean by leaving CPAP at the same level until able to maintain target SpO2 w/FiO2 <0.25
  3. Lower CPAP level by 1, pay attention to SpO2 for the first 6-24hrs (key is to see stabilizing FiO2 w/less support and less apneic periods)
  4. if there is no significant apnea w/SpO2 >85% after 2-days w/FiO2 = 0.21. d/c
  5. If d/c’d start NP @0.5-1 lpm
24
Q

What should you do after discontinuing CPAP?

A

Start nasal prongs at 0.5-1.0 lpm

25
Q

What should your initial SiPAP settings be? (3)

A
  • RR 20
  • Pressure at 9/6 (always want a delta of at least 3)
  • Ti 1 second
26
Q

What are your 2 Biphasic modes?

A
  1. BP-NCPAP (set IPAP and EPAP)
  2. NCPAP (set just CPAP)
27
Q

In Biphasic CPAP, when would you increase your Ti to 2 seconds?

A

When the Patient has increased FiO2 > 0.30

28
Q

In Biphasic CPAP, when would you increase your Ti to 3 seconds?

A

When the Pt further deteriorates from FiO2 >0.30

  • Decrease R to 15
  • Increase Ti to 3 seconds
29
Q

What are conditions for weaning Biphasic?

  • What should you do when d/c’d?
A
  1. SpO2 >85% for 80% of the time, mild WOB, and no significant apnea events.
  2. Initiate CPAP/SiPAP after d/c
30
Q

What guidelines should you follow with NPPV for pediatrics?

A

Similar to adults.

  • Focus on RR and WOB
  • Evaluate w/clinical assessments and ABGS
31
Q

What is the primary goal of NPPV? (4)

A

Decrease WOB and improve respiratory gas exchange.

  • Decrease WOB
  • Improve respiratory gas exchange
  • Increased FRC
  • Increased patency of the oral-pharyngeal airway and decreased intrinsic auto peep
32
Q

How do you know if you have effectively decreased WOB?

  • how is it manifested?
A
  • Decreased RR
  • Decreased retractions
  • Decreased use of accessory muscles of breathing
33
Q

How do you know if you have effectively improved respiratory gas exchange?

  • how is it manifested?
A
  • Decreased arterial PaCO2
  • Increased arterial PaO2
  • Increased arterial pH
34
Q

Benefits of Biphasic

A

Avoiding derecruitment, maintains optimal volume and FRC.

35
Q

Initial Biphasic CPAP settings?

A

RR 20

  • Pressure 9/6 (delta 3)
  • Ti 1 second
36
Q

Biphasic: Fio2 requirements increasing?

A

Increase MAP by Ti

Interventions 2 (RESP 319) (25 decks)

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