Respiratory arrest

Question 1

Airway management

Answer 1

Question 2

What organization published guidelines on non-invasive ventilation in 2002?

Answer 2

The British Thoracic Society (BTS) published guidelines on non-invasive ventilation in 2002.

Question 3

What organization published guidelines on non-invasive ventilation in 2008?

Answer 3

The Royal College of Physicians published guidelines on non-invasive ventilation in 2008.

Question 4

What are the key indications for non-invasive ventilation?

Answer 4

Key indications include:
1. COPD with respiratory acidosis (pH 7.25-7.35)
2. Type II respiratory failure due to chest wall deformity, neuromuscular disease, or obstructive sleep apnoea
3. Cardiogenic pulmonary oedema unresponsive to CPAP
4. Weaning from tracheal intubation.

Question 5

What is the pH range indicating COPD with respiratory acidosis for non-invasive ventilation?

Answer 5

The pH range is 7.25-7.35.

Question 6

What does the BTS guidelines say about acidotic patients with pH < 7.25?

Answer 6

NIV can be used, but greater monitoring (e.g. HDU) and a lower threshold for intubation and ventilation are required.

Question 7

What are the recommended initial settings for bi-level pressure support in COPD?

Answer 7

Recommended initial settings are:
- Expiratory Positive Airway Pressure (EPAP): 4-5 cm H2O
- Inspiratory Positive Airway Pressure (IPAP): 10 cm H2O (RCP) or 12-15 cm H2O (BTS)
- Back up rate: 15 breaths/min
- Back up inspiration:expiration ratio: 1:3.