NIPPV Basic Objectives Flashcards
Discuss the three basic noninvasive techniques
- negative pressure ventilation
- positive pressure NIV
- Abdominal-displacement ventilation
Discuss the clinical benefits (Acute care setting) of non-invasive positive pressure ventilation (NIV).
Clinical benefits of NIV:
1. Reduces need for endotracheal intubation
2. Reduces incidence of VAP
3. Shorten stays in the ICU
4. Shortens hospital stay
5. Reduces mortality
6. Preservers physiological airway defenses
7. Improve patient comfort
8. Reduces need for sedation
Discuss the clinical benefits (chronic care setting) of noninvasive positive pressure ventilation (NIV).
- Alleviate symptoms of chronic hyperventilation
- Improves duration & quality of sleep
- Improved functional capacity
- Prolong survival
Discuss the physiological benefits of noninvasive positive pressure ventilation (NIV).
Identify the selection and exclusion criteria for NIV application in the acute and chronic settings.
Explain the importance of the Humidification during NIV application.
Heated humidifier doing admin of nasal CPAP: significantly reduce drying of nasal mucosa and lead to improve patient comfort and compliance during NIV.
Passover end type heated humidifiers were often use because he did bubble humidifiers and HME, Inc. Raw & Interfere with pt. Triggering.
Describe the factors that will influence a fractional inspired oxygen concentration (FiO2), from a portable pressure – target ventilator.
Higher O2 flow rate results in higher O2 concentrations.
Lower IPAP and EPAP levels also your higher O2 concentrations.
FiO2 is affected by the type of leak port & site where O2 is added to the circuit. Leak port in the circuit, higher FiO2 value obtained, 02 is bled into patients mask. If the leak port is located in the mask, higher FO2 values are obtain, 02 is bled into the circuit at the machine outlet.
Identify a possible causes of a rebreathing CO2 during NIV administration from a portable pressure- target ventilator.
Gas flow is an adequate, exhale gases may not be adequate flesh for the system, resulting in the patient rebreathing exhale CO2.
APAP less than 4 cm of water and fast Respiratory rate, flow may not be adequate to flush CO2 from circuit. Use EPAP of 40 minutes water or higher to improve continuous flow gas for the system and minimize CO2 in breathing.
List the statues in the initiation of NIV.
- Patient an upright are sitting position. Explain procedure, goals and complications.
- Use a size engaged to ensure proper fit Size of mask.
- Attach interface to circuit of the ventilator. Turn on the ventilator and adjust to initial low pressure setting.
- Hold or allow patient a whole mass gently to face to become comfortable.
- Monitor oxygen saturation; adjust FiO2 to maintain saturation above 90%
- Secure mass to patient. Not too tight.
- Titrate IPAP and EPAP to achieve patient comfort, adequate exhale tidal volume, and synchrony with Ventilator. Monitor peak airway pressure delivered.
- Check for leaks and it just drops of necessary.
- Monitor respiratory rate, heart rate, level of dyspnea, saturation of oxygen, meant to ventilation, and exhale tidal volume.
- Obtain ABG value within one hour
Discuss several factors that affect the delivery aerosols during NIV.
- Type of aerosol generator (SVN, VMN (Vibrating mesh nebulizer) MDI)
- Position of the leak port
- Synchronization of MDI acquisition with inspiration
- IPAP and EPAP levels
- Presence or absence of a humidifier in the circuit
Identify several indicators of success for patients on NIV.
Time and commitment from the members of the healthcare team.
Understand the indications, benefits, and complications of NIV.
RT must commit considerable time to initiating and monitoring  NIV compared to invasive MV.
Hyper fit of the patient with an interface and to monitor and adjust ventilator settings. Time and patience to remain at the bedside and to instruct patient carefully, obtaining their full corporation.
Make recommendations for Ventilator changes based on observation of the patient’s respiratory status, acid-based status, or oxygenation status.
Decrease RR, reduce inspiratory muscle activity, synchronization with the vent. = refit or change mask
Insufficient IPAP level causes sustained or increase or are leading to an adequate VT delivery. = Incremental increase of IPAP to maintain exhaled tidal volume 6 to 8 L per KG lied to decrease RR.
Pt— Ventilator synchrony Improve by adjusting risetime, inspiratory sensitivity, expiratory flow cycling percentage, careful increase EPAP to offset auto peep.
Monitor oxygenation heart rate with pulse oximetry. If I had to adjust to maintain 90% to 92% stat. ABG one to two hours after initiation of NIV.
Recognize potential complications of NIV.
1. Mask discomfort
2. Nasal and oral dryness or nasal congestion from high flows.
3. Excessive lakes around mask
4. Pressure sores
5. Mouthpiece, lip seal leakage
6. Aerophasia, gastric distention
7. Aspiration
8. Mucus plugging
9. Hypotension
Provide optional solutions to complications of NIV.
- Check mask for correct size and fit
- Minimize headgear tension
- You spacers or switch mask style
- Use wound -care dressing over nasal bridge
- Add or increase humidification
- Irrigate nasal passages with saline
- Apply topical decongestants
- Chin-strap to close mouth
- Try full mask
- Nose clips
- Custom made oral pieces
- Louis effective pressures for adequate Vt delivery
- Simethicone agents
- Proper selection of patient = Can’t protect their own airway
- Adequate patient hydration
- Avoid excessive flow rate greater than 20 L per minute
- Short breaks from NIV, Allow for coughing
- Avoid excessive high peak pressure greater than 20 cm H2O
Describe two basic approaches to weaning the patient from NIV.
Reversibility of disease process that causes ARF. Patient condition stabilized.
- Mask removed for short periods of time based on tolerance of patient. Supplemental O2 administered. Monitor for respiratory distress and fatigue.
SVT trials,
- Reduce IPAP gradually to minimal level, patient perform more work breathing. Minimal level, NIV Discontinued.
