Test 1 Flashcards
(372 cards)
Define NIV.
The delivery of mechanical ventilation to the lungs using techniques that don’t require an endotracheal airway.
What are the three basic methods of applying NIV?
- Negative-pressure ventilation
- Positive-pressure ventilation
- Abdominal-displacement ventilation
Explain how negative pressure ventilators work.
The negative pressure is transmitted across the chest wall, into the pleural space, and into the intraalveolar space. Resulting in an increase in transpulmonary pressure causing air to enter the lungs.
List the clinical benefits of NIV in the chronic care setting. (4)
- Prolongs survival
- Improves duration and quality of sleep
- Alleviates symptoms of chronic hypoventilation
- Improves functional capacity
List 5 symptoms of chronic hypoventilation.
- Fatigue
- Morning headache
- Daytime hypersomnolence
- Cognitive dysfunction
- Dyspnea
What clinical indicators demonstrate improvement in patient comfort?
- Decreased respiratory rate
- Reduced inspiratory muscle activity
- Synchronization with the ventilator
What tidal volume range should be used with NIV and how is it manipulated?
5-7 mL/kg or greater. Volume is manipulated by increasing the difference between IPAP and EPAP. This is usually accomplished by increasing the IPAP.
What are the typical ranges for the inspiratory and expiratory settings on the BiPAP?
- IPAP: 2-30 cm H2O
- EPAP: 2-20 cm H2O
What role does NIV play in “end of life” situations?
- May relieve dyspnea
- Reduce sedation requirement
- Preserve patient comfort.
List four clinical disorders that manifest in chronic respiratory failure and require NIV as supportive therapy.
- Acute exacerbation of COPD
- Hypoxemic respiratory failure
- Community-acquired pneumonia
- Cardiogenic pulmonary edema
Describe how the use of NIV in the acute respiratory failure improves gas exchange.
By resting respiratory muscles and increasing alveolar ventilation.
What are some clinical benefits of NIV in the acute care setting? (7)
- Reduces need for endotracheal intubation
- Reduces incidence of VAP
- Shortens stay in the ICU
- Reduces mortality
- Improves patient comfort
- Reduces need for sedation
- Preserves physiological airway defenses
What is the physiological goal of NIV in ARF?
Improve gas exchange by resting respiratory muscles and increasing alveolar ventilation.
Invasive ventilation has been shown to be an effective and often necessary method to support alveolar ventilation; however, there are associated risks that can often result in ________________.
- Increased mortality and morbidity
- Higher financial cost
Use of negative pressure ventilators peaked during a world wide _____________ that peaked in the 1950s.
Polio epidemic
Negative pressure ventilators are also known as ________________.
Body ventilators
Negative pressure ventilators operated on the principle of _________________.
Increasing lung volumes by intermittently applying negative pressure to the entire body below the neck or just to the upper region of the chest. Exhalation is passive and depends on the elastic recoil of the lungs and chest wall.
The first successful negative pressure ventilator is commonly referred as the ____________.
Iron lung
Exclusion criteria for NIV (8)
- Hemodynamic instability
- Excessive secretions
- Agitated or confused patients
- Inability to protect airway
- Brain injury with unstable respiratory drive
- Uncooperative or unmotivated patients
- Facial deformities
- Respiratory arrest or the need for immediate intubation
Pressure targeted ventilators are __________-limited, ____________-triggered and ___________-cycled ventilators.
- pressure-limited
- flow and time-triggered
- time-cycled
What is shown to be effective in the treatment of acute cardiogenic pulmonary edema (ACPE)?
- Bilevel NIV
- CPAP
What were some cons of the negative pressure ventilators?
- Lack of portability
- Difficulty in providing routine nursing care
What form of positive pressure ventilation is known to be effective in the treatment of obstructive sleep apnea?
CPAP
____________ is considered by most clinicians to be a lifesaving application of ARF.
Noninvasive ventilation