NON INVASIVE POSITIVE PRESSURE VENTILATION

Question 1

GENERAL

Answer 1

Indications:
Rapidly reversible cause of respiratory failure with goal of resolution in 6-12 hrs

Conditions with best evidence for usage:
COPD
Cardiogenic Pulmonary Edema
OSA

Criteria
Cooperative
Mod-severe dysnpnea
Tachypnea (>24 breaths / min)
Increased WOB
Hypercapnic Respiratory Acidosis (pH 7.0 - 7.35)
Hypoxemia (PA02/Fi02 < 200mmHg)

Absolute C/i
GCS < 8
Resp / Card arrest
Condition requiring urgent intubation

Relative C/i
Impaired LOC
Hemodynamic Instability
Impaired cough / swallow
Copious secretions
GI bleed with significant emesis

Question 2

BiPAP

Answer 2

BiPAP
Indications:
MC NIPPV in ICU
COPD
Cardiogenic pulmonary edema

Mechanism:
Delivers EPAP (Expiratory Positive Airway Pressure; essentially CPAP) and IPAP (Inspiratory Positive Airway Pressure) synchyronyzed respiratory cycle

EPAP Mechanism / Benefits: Improves oxygenation by provides PEEP -> preventing collapse of small airways + recruits alveoli -> Increase SA and gas exchange

IPAP Mechanism / Benefits: Pressure support on top of PEEP -> reduces respiratory effort, increases tidal volume, improves ventilation

Starting / Titrating:
Start BiPAP at 15/8-10

THEN

Titrate to 20/8-10

Recheck ABG in 1-2 hrs Should see results in 2 hrs

Question 3

CPAP

Answer 3

CPAP
Indications:
Hypoxemic Respiratory Failure

Hypercarbic Respiratory Failure

Mixed Respiratory Failure

Mechanism:
Continuous positive airway pressure delivered throughout respiratory cycle

Patient breaths spontaneously from elevated baseline pressure selivered throughout respiratory cycle

Improves oxygenation by keeping airways open and recruited

PEEP: 5 -10 cm H20

Question 4

AIRVO

Answer 4

4-6 cm PEEP
Hypoxemic Respiratory Failure