Respiratory therapy Flashcards
Define oxygenation
- Getting oxygen from the lungs to the tissues
- Assessed by pulse ox
Define ventilation
1.Breathing in O2 and expelling CO2 - gas exchange within the alveoli
2. Assessed by ABG/VBG
How is poor ventilation treated vs poor oxygenation?
Oxygenation - oxygen therapy
Ventilation - NIV, mechanical ventilation, bagging
What are the pros of nasal cannula O2 therapy?
- low flow, well tolerated
- can eat, portable depending on devices
- can add humidity
What are the cons of nasal cannula O2 therapy?
Nose bleeds/irritation
Only low flow option (1-6L)
Mouth breathing
Unable to assess the amount of O2 a patient is truly receiving
What are the estimated amounts of O2 patients are actually receiving in relation to nasal cannula use?
room air - 21%
1L - 24%
2L - 28%
keep going up by 4’s
Outline the use of a simple mask for O2 therapy?
6L-10L
Pts that need more than nasal cannula
Need min 6L to avoid rebreathing CO2
CANNOT be humidified
Outline the use of a nonrebreather mask for O2 therapy?
Emergent use only (not long term)
10L-15L+ OR until bag no longer collapses with inspiration
Cannot be humidified & very drying
Outline the use of a venturi mask in O2 therapy?
Fixed FIO2
Great for COPD patients (hypoxic drive)
CONS:
-bulky
-cannot eat
-no humidity
-claustrophobia
Outline the use of a Sauter Valve (trach) for O2 therapy
Used for transport of tracheostomy patients requiring FIO2
Only for SHORT term use
CONS:
-cannot humidify
-very drying
-can lead to mucus plugging
Outline the use of an aerosol trach mask for O2 therapy?
Fixed FIO2 with humidification to avoid mucus plugging
CAUTION - do not lavage your patient
What is a HHFNC?
used when low flow O2 fails or transitioning from NRB
Up to 60L and 100% O2
high liter flow can provide SOME PEEP
What are the pros of HHFNC?
Humidified
Heated
Comfortable
Pt can talk, eat, etc
What are the cons of HHFNC?
High liter flow can still cause aspiration
cannot transport
What is CPAP?
One continuous level of pressure that helps splint open airway using positive end expiratory pressure (PEEP)
-decreases the work of breathing
What is intrinsic PEEP vs extrinsic PEEP?
intrinsic - the air always in our lungs after expiration, prevents lung collapse
extrinsic - pressure we add to decrease WOB and increase oxygenation by recruiting more alveoli
-helps with oxygenation, does not help eliminate CO2
What are some uses of CPAP?
OSA
hypoventilation syndrome
pulmonary edema
pushes fluid back into interstitial space
What are the cons of CPAP?
claustrophobia
pneumothorax
When is CPAP contraindicated?
patients cannot maintain their airway
vomiting
untreated pneumothorax
snoring respirations
obtunded
drowning in secretions
What is Bipap?
Bi-level positive airway pressure
IPAP and EPAP
What is IPAP
Inspiratory positive airway pressure (top number)
-controls the amount of CO2 expelled by increasing Vt along with respiratory rate
What is EPAP
Expiratory positive airway pressure (bottom number)
always less than IPAP
the difference in the two numbers makes a larger Vt which decreases CO2
What patients are BIPAP best for?
COPD patients with CO2 retention or impending respiratory failure who are still awake and alert
What are APAPS
average volume assured pressure support
- like bipap but with set Vt, RR, EPAP
-takes time to achieve volume
Why would you use AVAPS vs BIPAPs?
AVAPs gives you set Vt
more comfortable for patient
good for long term use
When is AVAP indicated?
Chronic hypoventilation syndromes
neuromuscular disease
respiratory failure not responding to BIPAP
clinically for those not maintaining good volumes
pts with distorted anatomy where BIPAP doesn’t work (ex large beard)
NOT and emergency mode
