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Topics of Respiratory Care > Test 1 Ch. 19 Basic Concepts of NPPV > Flashcards

Test 1 Ch. 19 Basic Concepts of NPPV Flashcards

1
Q

The delivery of mechanical ventilation to the lungs using techniques that do not require an endotracheal airway

A

Noninvasive ventilation

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2
Q

What are the three methods of applying NIV

A
  • negative pressure ventilation
  • positive pressure NIV
  • abdominal- displacement ventilation
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3
Q

Negative pressure ventilators peaked during a

A

worldwide polio epidemic that peaked in the 1950

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4
Q

What is another name for negative pressure ventilators?

A

body ventilator

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5
Q

Negative pressure ventilators operated on the principle of increasing

A

lung volumes by intermittently applying negative pressure to the entire body below the neck or just to the upper region of the chest

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6
Q

The first successful negative pressure ventilator commonly referred to as the

A

iron lung

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7
Q

Iron lung Is consistent of a large metal cylinder that enclosed the pt’s the entire body below the neck, leaving the

A

head protruding through an airtight rubber neck seal

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8
Q

What is the name of the smaller, portable negative pressure device?

A

chest cuirass (shell ventilator)

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9
Q

2 versions of the chest cuirass were primarily used to apply

A

negative pressure to the thorax and abdomen

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10
Q

_______ used a pressure-targeted ventilator (PTV) and a mask, later was used primarily to treat ARF complicated by COPD and asthma

A

Intermittent positive pressure ventilation (IPPV)

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11
Q

Intermittent positive pressure breathing (IPPB) used a

A

mask or mouthpiece; became a means of simply delivering aerosolized medication periodically w/ positive pressure breaths

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12
Q

What replaced IPPB?
Which treated?

A

Continuous positive airway pressure (CPAP);
OSA

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13
Q

The application of low levels of continuous airway pressure through a mask interface created a…..
which prevented….

A

pneumatic splint that prevented airway collapse during sleep

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14
Q

The use of NIV is successful in the treatment of chronic ventilatory insufficiency and

A

muscle weakness in pts w/ various neuromuscular illness

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15
Q

NIV has been used to treat both

A

acute and chronic respiratory failure

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16
Q

What is the primary goal for NIV in the acute care settings? (2)

A

To avoid the need for endotracheal intubation and invasive ventilation

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17
Q

What are some goals for NIV in the Acute Care Settings?

A
  • Reduces the need for ET intubation
  • Reduces incidence of VAP
  • Shortens stay in ICU
  • Shortens hospital stay
  • Reduces mortality
  • Preserves physiologic airway defense
  • Improves pt comfort
  • Reduces need for sedation
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18
Q

What is considered to be a lifesaving application for ARF?

A

Noninvasive positive pressure ventilation (NPPV)

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19
Q

The physiological goal of NIV in ARF is to improve

A

gas exchange by resting the respiratory muscles and increasing alveolar ventilation

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19
Q

What are some benefits of NIV in the Chronic Care Setting (4)

A
  • Alleviates symptoms of chronic hypoventilation
  • Improves duration and quality of sleep
  • Improves functional capacity
  • Prolongs survival
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20
Q

NIV reduces diaphragmatic pressure swings, which suggest that the

A

Respiratory muscles are being rested

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21
Q

When PEEP is applied during PSV, PEEP helps offset…

which reduces the work required to

A

auto-PEEP;
initiate inspiration

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22
Q

Pressure Support (PS) facilitates ______________, thus increasing the _____

A

inspiratory;
Vt

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23
Q

Pts w/ COPD who have experienced acute exacerbations have shown that NIV reduces inspiratory muscle activity and RR and increases Vt and minute volume, allowing for better

A

gas exchange and Respiratory muscle rest

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24
Q

Pts receiving NIV have shown significant improvement in (5) Within the first hour of use

A
  • vitals signs
  • pH
  • Blood gasses
  • RR
  • breathlessness
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25
Q

What are 2 examples of IPPV

A
  • metaNeb
  • IPV
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26
Q

NIV is typically used for

A

chronic vent failure

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27
Q

NIV= continuous ____________ _________

A

pressure breaths

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28
Q

IPPV= some of the breaths are….

A

given with pressure

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29
Q

What is the physiological goal of NIV in ARF in the acute and chronic care settings?

A

To improve gas exchange by resting the respiratory muscle and increasing ventilation

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30
Q

In pts who have COPD NIV has been

A

very successful

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31
Q

NIV in pts w/ asthma have been shown to be controversial, however it is used

A

in pts w/ status asthmatic

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32
Q

List 4 clinical disorders that manifest in chronic respiratory failure and require NIV as supportive therapy

A
  • Acute Exacerbation of COPD
  • Cardiogenic Pulmonary Edema
  • Hypoxemia Respiratory failure
  • Community-acquired PNA
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33
Q

NIV Community-Acquired PNA is considered controversial however success has been shown in pts w/

A

PNA and COPD

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34
Q

______ and mask _______ have been shown to be effective in the tx of acute cardiogenic pulmonary edema (ACPE)

A

BiPAP;
CPAP

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35
Q

NIV and mask CPAP w/o2 may expand fluid-filled alveoli, resulting in the following: (5)

A
  • Increased oxygenation
  • Increased FRC
  • Increased lung compliance
  • Reduced WOB
  • Reduced need for invasive ventilation
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36
Q

NIV CPAP w/ mask to treat ACPE has shown success w/ using

A

PSV plus PEEP

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37
Q

What is the recommendation range to use CPAP in the initial tx of ACPE

A

10 - 12 cm H2O

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38
Q

NIV is used in _____ ______ deformities and _____________ conditions that result in ___________ weakness, _______________, and eventually respiratory failure

A

chest wall;
neuromuscular;
muscle;
hypoventilation;

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39
Q

In Restrictive thoracic disorders NIV use……

A

is normally successful in these pts nocturnally

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40
Q

In CF NIV is

A

not often used

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41
Q

In CF _____________ use of NIV could help support these pts for several months while they……

A

intermittent ;
await a lung transplant

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42
Q

What does nocturnal hypoventilation include? (4)

A
  • CSA
  • obesity hypoventilation syndrome
  • OSA combined w/ COPD
  • CHF
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43
Q

What is the choice of NIV therapy used for OSA

A

CPAP

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44
Q

For OSA CPAP is typically used _____________ for ____ to ____ hrs and is used to overcome ______________ and ______________.

A

nocturnally;
4 to 6;
obstruction and desaturation

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45
Q

NIV provides a viable weaning alternative for pts who demonstrate

A

respiratory muscle fatigue post extubation

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46
Q

NIV reduces

A

WOB and maintains adequate gas exchange as effectively as invasive vetilation

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47
Q

What role does NIV play in “end of life” situations? (3)

A
  • it may relieve severe dyspnea
  • reduce sedation require intent
  • preserve pt comfort
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48
Q

In acute care settings NIV process must be based on the: (3)

A
  • Pt’s diagnosis
  • clinical characteristics
  • the risk of failure
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49
Q

The assessment process may be viewed as a two-step process. What are they?

A

1st step- establishing the need for ventilatory assistance
2nd step- exclude pts at increased risk for failure and complication

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50
Q

The final consideration in the selection of pts w/ ARF is the

A

potential reversibility of the disease process

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51
Q

Exclusion Criteria for NIV

A
  • Respiratory arrest or the need for immediate intubation
  • Hemodynamic instability
  • Inability to protect the airway
  • Excessive secretions
  • Agitated and confused pts
  • Facial deformities or conditions that prevent mask from fitting
  • Uncooperative or unmotivated pts
  • Brain injury w/ unstable respiratory drive
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52
Q

Typical symptoms of nocturnal hypoventilation and poor sleep quality include (5)

A
  • Excessive fatigue
  • Morning headache
  • Daytime hypersomnolence
  • Cognitive dysfunction
  • Dyspnea
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53
Q

What are some other indications for NIV in pts

A
  • Obesity hypoventilation syndrome
    (extremely overweight pts who take short breaths, which causes a chronic high CO2)
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54
Q

What are the equipment generally required for NIV? (3)

A
  • ventilators
  • humidifiers
  • interfaces or mask
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55
Q

Types of ventilators (3)

A
  • Portable homecare ventilators
  • Adult acute care ventilators
  • Portable pressure support (pressure- targeted) ventilators
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56
Q

The choice of ventilators should be based on the

A

level of support required and the advantages and disadvantages of the appropriate machines

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57
Q

What are another name(s) for pressure-targeted ventilators (PTVs)? (3)

A
  • Bilevel CPAP ventilators
  • Pressure support ventilators
  • Bilevel pressure ventilators
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58
Q

PTVs are _____________-controlled electrically powered units that use a blower to regulate _____ flow to the pt’s ________ to maintain the preset __________ levels at the pt’s connection

A

microprocessor;
gas;
ciruit ;
pressure

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59
Q

PTVs typically delivers a

A

Vt

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60
Q

Some PTVs are

A

pneumatically powered which means it needs a gas source to run

61
Q

PTVs are…. (3)

A
  • Pressure limited
  • Flow and time triggered
  • Flow and time cycled
62
Q

Pressure limited means it will only

A

reach a certain pressure; the pressure that was set and that will be the highest pressure it can go to

63
Q

Flow triggered means it will

A

sense what the pt is doing and it will allow the pt to trigger a breath

64
Q

Time trigger is a

A

set rate; the machine will give a breath, weather the pt wants to or not

65
Q

Flow cycled means

A

the pt can end the breath

66
Q

Time cycled means if the pt

A

does not end the breath, the machine can

67
Q

PTVs are designed to improve gas exchange and increase VE using

A

IPAP and EPAP

68
Q

What is the calibrated pressure range for IPAP and EPAP?

A

IPAP= 2 to 30 cm H2O
EPAP= 2 to 20 cm H2O

69
Q

Most PTVs offer the following modes of ventilatory support: (3)

A
  • CPAP (spontaneous)
  • PSV (IPAP/EPAP)
  • Spontaneous/timed (S/T)
70
Q

In CPAP mode the pt breaths spontaneously at a set…..
The pt controls both the

A

baseline pressure;
rate and depth of breathing

71
Q

CPAP mode is 1 ____________ positive pressure

A

continous

72
Q

CPAP is typically used for (2)

A
  • Hypoxemic Respiratory Failure
  • Cardiogenic Pulmonary Edema
73
Q

With PSV (bilevel) mode, the difference between……..

A

2 pressure levels (IPAP and EPAP) determines the level of pressure support for each assisted breath

74
Q

In S/T mode the clinican set the (3)

A
  • IPAP and EPAP
  • RR
  • Inspiratory time ( IPAP%)
75
Q

In S/T spontaneous breaths are given, however

A

timed breaths are given as well

76
Q

S/T is similar to

A

SIMV

77
Q

PSV=

A

IPAP and EPAP

78
Q

S/T=

A

IPAP & EPAP
RR
I times

79
Q

What is the difference between PSV and S/T

A

PSV- set IPAP and EPAP and hope that the pt breathes as they should breathe

S/T- set RR and I-times to give breaths, if the pt does not

80
Q

Average volume-assured pressure support (AVAPS) automatically

A

adapts the pressure support to match a pts ventilatory needs by delivering an average Vt (Vt= 200-1500 mL)

81
Q

How do you figure out the Pressure support is being applied to the pts airway

A

The difference between IPAP and EPAP
(ex. pt has an IPAP of 10 and an EPAP of 5. The pt is getting 5 of pressure support. 10-5= 5)

82
Q

AVAPS devices operate w/ several modes of ventilation including: (5)

A
  • CPAP
  • S/T,
  • spontaneous
  • timed
  • PCV
83
Q

What does Auto- Trak+ option allows the clinician to do what?

A

Adjust thresholds that manage trigger and cycling and the level of Auto-Trak sensitivity

84
Q

AVAPS include a target Vt of __, minimum IPAP of ____, minimum EPAP of ___, RR ___ to ___ below resting RR, and an inspiratory time of ____ seconds

A

8 mL/kg IBW
25 cm H2O;
+4 cm H2O;
2 to 3 beats/min;
1.5

85
Q

PTVs allow adjustment of the amount of time required to reach IPAP, which is called?

A

Rise-time control

86
Q

Rise time is the amount of time until you reach the

A

maximal pressure or maximal volume.

87
Q

In NIV rise time control is the time to

A

reach IPAP

88
Q

Ramp allows positive pressure to

A

increase gradually over a set interval (delay time).

89
Q

Ramp rate generally can be set in increments of..

A

1, 2, 3 cm H2O

90
Q

Delay can be set in increments of ___ minutes between

A

5 ; between 5 and 30 minutes

91
Q

When are ramp and delay time more likely to be used in? (2)

A
  • homecare
  • chronic care NIV
92
Q

Portable PTVs have certain limitations. When supplemental O2 is required, what must be done?

A

It must be bled into the system via the mask or into the circuit near the machine outlet

93
Q

Therefore the FiO2 can vary and can be affected by 4 factors. What are they?

A
  1. O2 flow rate
  2. Type of leak port in the system
  3. Site where O2 is bled into the circuit
  4. IPAP and EPAP
94
Q

Rebreathing of CO2 is a concern w/ any PTV that uses a single-circuit gas delivery system b/c….

A

exhalation occurs through the intentional leak port and depends on the continuous flow of gas in the circuit

95
Q

What are the advantages of portable homecare ventilators?

A
  • electrically powered, microprocessor-controlled ventilators
96
Q

Portable homecare ventilators were capable of providing

A
  • patient-or time-triggered
  • pressure-limited
  • volume - or pressure-cycled
97
Q

This type of vent has no graphic display and very basic alarms. Low pressure, high pressure, power switchover, apnea

A

portable homecare vents

98
Q

How could PEEP be obtained w/ PHV?

A

attaching an external threshold resistor to the pt circuit exhalation valve

99
Q

PHV were not equipped w/ internal blenders and therefore

A

precise O2 concentration was not possible

100
Q

As with PTVs, PHV, O2 had to be

A

bled into the system through an adapter O2 source

101
Q

Vents used in adult care units offer additional ventilatory support options and…

A

alarms and a precise FiO2 and monitoring features than portable PTVs

102
Q

What is the most significant disadvantage of using an acute care vent?

A

The inability of machines to compensate for leaks

103
Q

Leaks at the interface interfere w/ triggering and __________ functions of the vent and results in pt- ____________ _____________ and increased WOB

A

cycling;
ventilatory asynchrony;

104
Q

Using a heated humidifier can significantly

A

reduce drying of the nasal mucosa in nasal CPAP

105
Q

What are the 2 different modes for heated humidifcation

A

Invasive and Noninvasive

106
Q

Passover-type heated humidifiers are often used b/c

A

heated bubble humidifier and HME can increase Raw in the ventilator circuit and interfere w/ pt triggering and increase inspiratory WOB

107
Q

The effectiveness of NIV is greatly influenced by the __________ chosen to deliver __________ pressure

A

interface;
positive

108
Q

Carefully explaining the process and repeating the explanations as the process continues can

A

improve patient compliance

109
Q

What are the initial pressure for NIV?
EPAP and IPAP

A
  • EPAP pressure of 4 to 5 cm H2O
  • IPAP pressure of 8 to 10 cm H2O
110
Q

Pt tolerance and comfort w/ the system are important to ensuring the effectiveness of NIV at alleviating

A

respiratory distress

111
Q

Improvement in pt comfort w/ NIV is indicated by (3)

A
  • decreased RR
  • decreased inspiratory muscle activity
  • synchronization w/ the vent
112
Q

Insufficient IPAP levels often result in sustained or increased…

A

RR caused by inadequate Vt delivery

113
Q

Slowly increasing the IPAP to maintain the exhaled Vt at (#)

A

6 to 8 mL/kg may result in a decrease in the RR

114
Q

The FiO2 is adjusted to maintain SpO2 at (range)

A

90% to 92%

115
Q

Shortly after the initiation of NIV, (1 to 2hrs) the adequacy of ventilatory support is determined by

A

ABG results

116
Q

When is NIV terminated in favor of invasive measures?

A
  • pH and PacO2 continue to worsen or show no improvement, accompanied by Respiratory distress
  • Worsening level of consciousness
  • hemodynamic instability
  • worsening oxygenation
117
Q

Complications w/ NIV are usually related to (3)

A
  • mask discomfort (most common)
  • air pressures
  • gas flow
118
Q

When can you discontinue NIV?

A

Depends on how quickly the cause of the respiratory failure can be reversed

119
Q

Pt w/ ARF successful weaning from NIV may occur within

A

hours or a few days

120
Q

Standard weaning techniques have not been established most common approach involves increasing

A

periods off mask ventilation

121
Q

In the same manner of SBT, periods off the ventilator lengthen as the underlying condition improves and the pt shows (3)

A
  • acceptable vital signs
  • good gas exchange
  • no respiratory distress
122
Q

_______________ _____ is administered as necessary during these times off the vent

A

Supplemental O2

123
Q

Studies have shown that more time is required during an intial

A

8hr shift to institute NIV than to establish conventional invasive ventilation

124
Q

CPAP main goal is to help w/

A

oxygenation

125
Q

For CPAP, to improve o2 you must

A

increase pressure and FiO2

126
Q

CPAP has ___ continuous pressure

A

1

127
Q

BPAP has __ pressures _____ and _______

A

2;
IPAP & EPAP

128
Q

IPAP (CO2)=

A

Vt and PIP

129
Q

EPAP (O2)=

A

PEEP

130
Q

IPAP-EPAP=

A

Pressure support

131
Q

For BiPAP if you have high CO2,

A

increase IPAP (Larger Vt) to blow off CO2

132
Q

For BiPAP if you have low CO2 then you

A

decrease IPAP to retain CO2

133
Q

To increase oxygenation on BiPAP you

A

increase EPAP

134
Q

To lower O2 or weaning from BiPAP you

A

decrease EPAP

135
Q

Criteria for Terminating NIV and Switching to Invasive MV (Box 19.6)

A
  1. Worsening pH and PaCO2
  2. Tachypnea (>30 breaths/min)
  3. Hemodynamic instability
  4. SpO2 < 90%
  5. Decreased level of consciousness
  6. Inability to clear secretions
  7. Inability to tolerate interface
136
Q

What is the criteria for Acute Respiratory Failure in adults (NIV)

A
  • pH <7.35
  • PaCO2 > 45 mm Hg
  • PaO2/FiO2 < 200
137
Q

To prevent CO2 rebreathing, EPAP level should be set at ___ cm H2O or higher so adequate gas exchange can flush CO2 from the breathing circuit

A

4

138
Q

Chart 19.1
What are the symptoms indicating the need for NIV (4)?

A
  • Moderate to severe dyspnea
  • RR greater than 24 breaths/min
  • Accessory muscle use
  • Paradoxical breathing
139
Q

What is the corrective action for the complication that is associated w/ Mask CPAP/NIV therapy?

Hypotension

A

Avoid excessively high peak pressures (<20 cm H2O)

140
Q

What is the corrective action for the complication that is associated w/ Mask CPAP/NIV therapy? (3)

Mucous plugging (3)

A
  • Ensure adequate hydration
  • Adequate humidification
  • Avoid excessive O2 flow rates
141
Q

What is the corrective action for the complication that is associated w/ Mask CPAP/NIV therapy?

Aspiration

A

Adhere to proper selection of pts who can protect their own airway.

142
Q

What is the corrective action for the complication that is associated w/ Mask CPAP/NIV therapy?

Aerophagia, gastric distention

A

Use lowest effective pressures for adequate VT delivery

143
Q

What is the corrective action for the complication that is associated w/ Mask CPAP/NIV therapy?

Pressure sores

A

Use wound-care dressing over nasal bridge

144
Q

What is the corrective action for the complication that is associated w/ Mask CPAP/NIV therapy?

Excessive leaks around mask (2)

A
  • Minimize headgear tension
  • Switch mask style
145
Q

What is the corrective action for the complication that is associated w/ Mask CPAP/NIV therapy?

Nasal/oral dryness or nasal congestion (4)

A
  • Add or increase humidification
  • Irrigate nasal passages w/ saline
  • Apply topical decongestant
  • Use a chin strap to keep mouth closed
146
Q

What is the most common complication of NIV

A

Mask discomfort

147
Q

Insufficient ______ levels often result in sustained or increased RR caused by inadequate Vt delivery

A

IPAP

148
Q

You notice a drop in exhale Vt on a pt on BiPAP. What is the most appropriate action to take?

A

Adjust the interface
(#1 reason for exhale Vt to be lower or less than expected is a LEAK. The first place you will have a leak is the face mask)

149
Q

What is the most appropriate type of humidifier for NIV?

A

Pass-over
(except for transport)

150
Q

Pt is on mask CPAP w/ FiO2 80% and CPAP of +8. ABG values are pH 7.37, PaCO2 37, PaO2 55. What is the most appropriate thing to do next??

A

Increase CPAP
(If FiO2 is between 50% to 60% or up then you will increase the pressure)

151
Q

A pt w/ COPD is on BiPAP w/ the following settings: IPAP 8, EPAP 4, Vt 350mL. Their ABGs values are: pH 7.27, PaCO2 77, PaO2 50. What is the most appropriate thing to do next?

A

Increase IPAP
(Fixing IPAP should increase pH and o2 as well)

Topics of Respiratory Care (20 decks)

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