NPPV

Question 0

Airon pNeuton

Answer 0

Pediatric and adults weighing 23kg or more

Modes- Nonsynchronized IMV(PC or VC), CPAP

Entirely pneumatic, MRI capable

FiO2 options are set at wither 100% or 65%

Built-in PEEP (0-20), trigger sensitivity does not need to be readjusted with changes in PEEP.

Question 1

Impact Univent 750/754

Answer 1

For pediatric and adult transport

Modes- Control, A/C, SIMV (time-triggered, volume targeted)
Set rate and I-time and flow to determine Vt on 750, set Vt directly on 754

Powered by both pneumatic and electric
Requires either A/C or D/C power, battery life ~9 hours

Fio2 regulated with external blender, no entrainment

Requires external PEEP valve, but compensates for the PEEP automatically or manually.

Features on 754, not on 750
Vt setting, back-up ventilation, pressure plateau ventilation, Internal PEEP, blender, FiO2 display, compressor

Question 2

LTV 1200, 1000, 950, 900, 800

Answer 2

LTV 100 overview

Rotary compressor generates gas flow
Preset bias flow of 10 L/min
Accumulator blends gas and acts as acoustic silencer
AC or DC power, batter life of 60 mins
Exhalation valve controls PEEP, no compensation
Fixed orifice pneumotacometer at the wye
Set inspiratory pressure = PIP
Flow-triggered spontaneous breaths
Increasing tidal volume will decrease FiO2

1200 and 1000 have built in O2 blender and provide PCV, low-pressure oxygen source

950 has NO blender but provides PCV

900 has flow-triggering, volume ventilation, and PS, but no blender or PCV

800 and 900 have volume-targeted mandatory breaths only, the 800 is strictly pressure triggered, volume controlled without PSV

Extended feature

Rise time- active for pressure targeted breaths (PCV, PS), adjust rate of pressure and flow delivery between 1-9 with 1 being the fastest rise time.

Flow term %- percent of the peak inspiratory flow at which the vent will cycle a pressure support breath from inhalation to exhalation. Range is 10-40%, with 25% the default.

Time term- maximum time for inspiration (0.3-3.0 seconds), will time-cycle the breaths if reached before the flow term

PC flow term- same as flow term for PS but for PCV.

Leak compensation- tracks baseline flow, will compensate up to a 6 L/min leak.

Question 3

PB LP10

Answer 3

Modes
AC (volume control, or pressure control)
When pressure control set, waveform is altered allowing for a plateau to occur during inspiration.
Volume-targeted SIMV
Pressure cycled mode

Power sources include AC and DC
Rotary drive piston created sinusoidal waveform
Pressure transducer monitors airway pressures

FiO2 delivered at 0.40 by bleeding O2 directly into the circuit, or 1.0 by delivering O2 directly into the rear panel.

No internal PEEP, compensate for external PEEP by adjusting the trigger sensitivity up to 10+. If sensitivity is set above the PEEP, auto-cycling may occur.

Question 4

BiPAP S/T-D30

Answer 4

Modes- CPAP and S/T
Power source (AC or DC, internal 20-60 min back up battery)
Set % IPAP time
Triggered by 6ml volume above base-flow, EPAP cycle
Cycles if 3 seconds reached, pt flow<shape signal, exp. threshold met

Question 5

BiPAP VISION

Answer 5

AC powered ~6 hour battery
Uses 50psi oxygen source, internal blower for air, single limb circuit

Modes
CPAP and S/T modes (time triggered, time cycled in S/T)
Triggered by 6ml volume above base-flow, pt flow exceeds shape signal
Cycles if pt flow<shape signal, flow reversal, SET achieved, 3 seconds

Question 6

V60

Answer 6

Can provide noninvasive and invasive support in adults and peds

AC powered, ~6 hour battery, 50psi O2 source, internal blower

Modes
CPAP, PCV, PPV, AVAPS, S/T

Uses AutoTrak to trigger breaths and cycles spontaneous breaths and AVAPS mandatory breaths
Continuous leak compensation (modifies expiratory flow rate and Vt)

Question 7

Drager Carina

Answer 7

Modes
  AC (VC, PC) 
  SIMV (Autoflow, PC)
Spontaneous modes
  PSV (Vt guarantee, CPAP)

Integrated blender, internal battery
FDA approved for trach’s and ETT’s

Sync plus= automatic leak compensation, cycle learning, multisense triggering by monitoring flow and pressure

AutoRamp= stimulates natural breathing, optimizes flow to pt
No HME’s, use standard humidifier

Question 8

Basics of NPPV

Answer 8

Acute care goals
-Avoid intubation, relieve symptoms, enhance gas exchange, improve synchrony, maximize comfort, decrease length of stay

Chronic care goals
-Relieve/improve symptoms, improve QOL, increase survival/mobility

Indicated disease processes
-COPD exacerbations, asthma, acute cardiogenic pulmonary edema with hypercapnia during CPAP, CAP (in COPD pts), hypoxemic respiratory failure, immunocompromised pts, DNI’s, postop, difficult to wean pts.

Selection criteria
-Accessory muscle use, paradoxical breathing, RR>25, dyspnea, PaCO2 >45, pH<200

Exclusion criteria
-Apnea, hemodynamic instability, uncooperative, facial trauma, risk of aspiration high, copious secretions, untreated pneumo, abnormalities

Predictors of successful NIPPV
-minimal leaks, lower severity of illness, respiratory acidosis, improvement in gas exchange within 30mins-2hrs, improved HR, RR