non-invasive ventilation Flashcards
what is a Diaphragmatic Pacing
surgically implanted nerve stimulator which
allows for ventilatory support in selected
patients with chronic ventilatory insufficiency
indication of Diaphragmatic Pacing
- central alveolar hypoventilation
- brainstem injury or disease
- spinal cord injury or disease at or above C3-C5
- damaged phrenic nerve(s)
what are the criteria for using diaphragmatic pacing
- intact nerves with normal function
- adequate lung function with normal
compliance - ability to understand and manage pacing
- patent upper airway
Contraindications of Diaphragmatic Pacing
- phrenic nerves degenerated
• no diaphragmatic response to electrical
stimulation
• compromised lung function
what is the components of a Diaphragmatic Pacing
- Electrodes
- -> monopolar or bipolar
- Receiver
- Transmitter
- Antennae
fxn of Transmitter
sets respiratory rate and
length of inspiration (powered by battery)
–generates a coded
radiofrequency signal, so that it cannot be disrupted
fxn of Antennae
transfers signal across intact
skin to the receiver
fxn of Receiver
obtains signal and energy from
external portion by inductive coupling.The
receiver is placed in a subcutaneous pocket
fxn of Electrodes
stimulates the phrenic nerve
What are the controls of the transmitter?
- On switch
- RR control (# of pulse
trainsmitted/min) - Insp Period (It )
- Three controls for Vt
…. Stimulus Amplitude
… Pulse interval
…. Pulse Width
Benefits of Diaphragmatic Pacing
- Cost effectiveness
- Lower infection rates
- Improved venous return
- Normal breathing and speech return
- Ease of eating and drinking
- Increased patient mobility
how to clean pacer
Autoclave electrodes and antenna/radio receiver
before implanting. Do not gas sterilize…ETO
residue or other chemicals can cause severe tissue
reaction
What is the indication of NIPPV?
- Hypoventilation syndromes
- OSA and CSA
- Palliative
wat is the contraindiation of NIPPV
- Inability to protect airway
- –> Secretions
- –> Patent
- Pressure related complications
- –> Sinusitis etc
- Inability to use interface properly
- –> Facial issues
- –> Cooperation
- High FiO2
What are the devices used for NIPPV?
Conventional ventilators
Bi Level Devices
wt are the bilevel device used ?
BIPAP(respironics), VPAP(resmed)
what are te modes of BiPAP
- CPAP
- S
- S/T
- T
- PC
what are the therapy features of bipap
- AVAPS
- AVAPS rate
- Bi-Flex٭
- Ramp
- Rise Time٭
- Digital Auto-Trak
external Battery of Bipap?
Up to 5 hours Power
what are the main settings of Bipap
- IPAP 4 to 40cmH2O
- EPAP 4 to 25cmH2O
- BPM 0 to 40
what is the purpose of AVAPS
AVAPS will help patient maintain a VT equal
to or greater than the set VT
how does AVAPS achieve its fxn
automatically controlling the PS provided to the patient
- by varying the IPAP level between the IPAP Min and IPAP Max settings (or PSmin and PSmax)
Which mode is biflex available in
S mode
same as Cflex in CPAP
indication of VPAP?
provide noninvasive ventilation due to respiratory
insufficiency or OSA patients >30 lbs
fxn of vsync of VPAP
adjust the baseflow so that patient doesnt have to work as hard to trigger
what does high, ed, low trigger and cycling mean
high–>easiest
low–>hardiest
fxn of IBR
Intelligent Back Up Rate
it mimics patient breathing pattern in the background, when patient goes apneic, ventilator will provide breath similar to patient pattern
What is IVAPS
Intelligent volume-assured pressured support
indication for IVAPS
patient over 66ibs
indication for stellar
provide ventilation for nondependent,
spontaneously breathing pt with
respiratory insufficiency, or respiratory failure,
with or without OSA
what are some common alarms used in BIPAP, VPAP, stellar
- Power failure
- Apnea (not on VPAP3)
- Low pressure
- High pressure
- Low volume
how is fio2 affected in these machine
by flow and leak
How are patient qualified for CPAP
documented sleep apnea – level 1
polysomnography
AND
significant symptoms/risks that are reversed with
treatment
How are patient qualified for Auto-Titrating Positive Airway Pressure APAP
1.qualified for CPAP
AND
2.patients with prescribed fixed CPAP level of
10 cmH2O a minimum change of 4cmH2O between
REM and NREM
What does the ADP funding package include for BIPAP, CPAP and APAP?
(i) a positive airway pressure device;
(ii) a heated humidifier;
(iii) a basic mask and headgear;
(iv) carrying case;
(v) 6 ft. tubing;
(vi) all necessary caps and filters,
(vii) user instruction manual
**patient dont have to pay out of the pocket for these components
