Non-Invasive Ventilation Flashcards
how would you describe nCPAP in layman’s terms
it is spontaneously breathing at an elevated baseline
what are the goals and physiological benefits of NIV
- decrease WOB (decrease RR, retractions, accessory mm use)
- improve gas exchange (decrease PaCO2, increase PaO2, pH)
- improve FRC and thus V/Q
- reduce auto-PEEP
- improve upper airway patency
- stabilizes chest wall and upper airway
- protects developing lung from pressure
- surfactant recycling/type II pneumocyte function
- reduced intubation and MV
- stimulates J receptors
- weaning
indications for nCPAP
- respiratory distress
- tachypnea
- retractions/accessory mm use
- grunting
- nasal flaring
- head bobbing - abnormal breathing patterns
- apnea of prematurity
- obstructive sleep apnea - lung disease
- decreased lung volumes on chest radiograph
- pneumonia
- RDS
- PaO2 <50 with FiO2 >/= 0.50 - other
- post extubation failure
why NIV for neo?
- less intubation, prevents BPD, better mother-baby bonding, less complications as MV
- great option over MV d/t advancements in prenatal care and early surfactant administration
nCPAP contraindications
- upper airway malformations
- respiratory failure (co2>60, pH < 7.25)
- congenital diaphragmatic hernia
- neuromuscular disorders
- CNS depression
- central or frequent apneas
components of ideal CPAP system
- gas source
- precise o2 blending
- humidifier
- circuit (lightweight, prevention torque, encourage comfort)
- pressure measuring device (high/low P alarm, safety pop off)
- comfortable interface
bubble CPAP
- height of water determines expiratory resistance, creates PEEP/CPAP
- constant flow generator or 6-10LPM, enough to meet PIF demands and clear exhaled CO2 to avoid rebreathing
- water level: 3-10 cmh2o
- manifold components: pressure relief (17), oxygen monitoring, pressure monitoring
SIPAP
- variable flow generator CPAP
- device components: 2 flowmeters (NCPAP sets baseline flow, Biphasic handles Pinsp demands/high pressure limit); FiO2 dial control, inspiratory limb, proximal pressure line, abdominal transducer input
what’s the fluidic flip?
- gas flow dynamic (coanda effect)
- exhaled flow creates turbulence and d/t drop in pressure at narrow orifice, the incoming fresh gas flow is redirected/pulled closer to the expiratory limb wall which decreases WOB on exhalation
how do we know NIV is working?
- Vitals (normal RR, BP, HR, SpO2)
- TcCO2
- ABG
- WOB
NIV weaning
need: stable vitals, ABG/Transcutaneous, no apnea spells, good CXR
- wean FiO2 first, pressure second to maintain recruitment
options
1. decrease CPAP then remove once reach 5 cmh2o
2. removing for pre-set duration then gradually increasing time off
3. discontinue and transition to HHFNC
troubleshooting NIV
preventing leaks
- soother
- chin strap
- calm the baby
causes of air leak
- pneumothorax
- pulmonary interstitial emphysema
- pneumomediastinum
- penumatocele
calm environment to decrease stress and WOB
- decrease light, noise, handling
- prone position
mouth care
- prevent the dry secretions from building up
CPAP belly
- adequate size OGT to aspirate air
