Unit 2: CPAP, BiPAP & Mechanical Vents Flashcards
CPAP and BiPAP are what kind of Pressure ?
what do they DO?
- PUSH air
- (+) Pressure—prevent collapse of bronchioles and alveoli
CPAP
the “C” stands for….
CONTINUOUS
*Inspiration ONLY
BiPAP
“Bi” stands for….
Biphasic
- 2x–> INSP and EXP pressure
- NOTE: APPLE shaped== abdomen weight==more likely CPAP
CPAP and BiPAP are _______pressure
Non-Invasive
CPAP and BiPAP
Goals:
- PREVENTS bronchial collaps
- Improves Gas exchange
- DECd work of breathing
- IMPROVES ventilation in V/Q matching
CPAP and BiPAP improves gas exchange
3 ways:
- INC FiO2 in residual volume
- Maintaining open alveoli
- Optimizing V/Q
How is CPAP delivered?
2 Ways
- Mask
- Tracheostomy Tube
CPAP
- Mask
explain
- Face mask CPAP machine
-
For:
- sleep apnea
- weak diaphragm
- *optimizing V/Q
CPAP
- Tracheostomy Tube
Explain…
- Tracheostomy CPAP setting on Ventilator
-
For:
- weaning FROM MV
- **> 2 hr CPAP wean w/ stable vitals (RR <30bpm) is a GOOD INDICATOR for weaning potential
CPAP
*Continuous Positive Airway Pressure
Fun Facts
- ONLY 1 PRESSURE SETTING
- Continuous POSITIVE PRESSURE t/o breathing cycle
- SETTING: 5-25 CmH2O
- *DOES NOT have mandatory RR
BiPAP
Bilevel Positive Airway Pressure
2 Settings:
- INSP phase (iPAP)
- EXP phase (ePAP)
BiPAP
iPAP phase vs. ePAP phase
- iPAP is provided on ea. pt triggered breath FOLLOWED BY an ePAP
BiPAP Settings
iPAP vs. ePAP
-
iPAP
- == 4 to 30 cmH2O
-
ePAP
- == 2 to 20 cmH2O
*carry to mech. vent–> we want AS LOW AS POSS.–> less assist ==BETTER!!!
BiPAP has additional setting for RR:
what does this do?
- Machine forces breath if pre-set time passes w/ apnea
- Setting avg is 10-12 breaths per minute
Mechanical Ventilator is _______pressur support
INVASIVE
WHY does a pt. need Mechanical Ventilation?
4 reasons:
- Airway obstruction
- Pt unable to control oral secretions==Freq. aspirations
-
NON-effective/NON-productive cough
- Inability to clear bronchial secretions
- Need for positive-pressure system
HOW is Mech. Vent delivered?
3 Ways:
- Nasal Pharyngeal Tube
- SHORT-TERM
- Oral ET Tube
- Tracheostomy Tube (can have Cuffed adult trach. tubes)
-
Sx incision INTO trachea
- LONG-TERM 2-3d
-
Sx incision INTO trachea
Nasal Pharyngeal Tube
Mech. Vent.
see pics
Oral ET Tube
see pics
Tracheostomy Tube
Sx incision
LONG TERM
see pics
PTs SHOULD DO Prio/During PT session AND document these components of Mech. Vent.
7:
- Mode of Ventilation
- FiO2==20.98 or ~21%
-
PEEP (Positive End-Exp Pressure)
* HOW MUCH CPAP provided– mmH2O
-
PEEP (Positive End-Exp Pressure)
- RR –bpm
- Tidal Volume (VT) – mL
- Alarm settings
-
Minute Ventilation (VE) –mL/min
* VE==RR*TV
-
Minute Ventilation (VE) –mL/min
MODE of Mech. Vent
see pics
Mech. Ventilation MODES
Modes via Pressure-Control vs. Volume-Control
Talk about Volume-Controlled Mode:
Volume-Controlled Mode:
-
Assist-Control (A/C or CMV)
- SET volume for ea. breath
- Synchronized Intermittent Mandatory Ventilation or SIMV
Mech. Ventilation MODES
Modes via Pressure-Control vs. Volume-Control
Talk about Pressure-Controlled Mode
Pressure-Controlled Mode:
- Continuous Positive Airway Pressure or CPAP
-
Pressure Support Ventilation or PSV
- COMMON
- works on PRESSURE
- INSP (+) pressure
MODES of Mech. Vent
Modes via Controlled vs. Spontaneous
Talk about Controlled Modes
Controlled Modes:
- Assist-Control (A/C or CMV)
MODES of Mech. Vent
Modes via Controlled vs. Spontaneous
Talk about Spontaneous Modes
Spontaneous Modes:
- Synchronized Intermittent Mandatory Ventilation or SIMV —> VOLUME CONTROLLED
- Continous Positive Airway Pressure or CPAP—> PRESSURE CONTROLLED
- Pressure Support Ventilation or PSV —> PRESSURE CONTROLLED
2 VOLUME CONTROLLED Modes:
- Assist-Control (A/C or CMV)
- Synchronized Intermittent Mandatory Ventilation or SIMV–> Trauma Units
Volume Controlled mech. vents
Assist-Control (A/C or CMV)
- All breaths are Identical whether triggered by patient OR machine
- Pt. can only trigger breath when it falls @ a HIGHER RR than pre-set
Volume Controlled Mech. Vent
Synchronized Intermittent Mandatory Ventilation (SIMV)
- Machine pre-set lower RR w/ pre-set VT but when pt triggers a breath the pt controls EVERYTHING
-
partially spontaneous
- This is your intermittent—synchronized to get a forced breath
* Pt controls some and machine controls some
Pressure Controlled mech. vents
2 types:
- Continous Positive Airway Pressure CPAP
- Pressure Support Ventilation PSV
Pressure Control Mech Vents
Continous Positive Airway Pressure CPAP
- ONLY CPAP pressure is set
- TOTALLY SPONTANEOUS
- CPAP pressure is the same as PEEP used during other MV modes
Pressure controlled MV
Pressure Support Ventilation
PSV
- Provides Positive Pressure during INSP (iPAP) AND EXP (PEEP)
- *Can be used in conjuction w/ SIMV
Settings: Pre-set vs. Actual
FiO2:
60% or LESS ====
GREEN LIGHT for ALL THERAPY
Settings: Pre-set vs. Actual
FiO2:
>60% ===
YELLOW LIGHT for Basic ADL/Bed Ex’s
*CAUTION
- Consult w/ MDs, RTs, and nursing to det pts O2 reserve and ability to participate in mobility w/out sig. O2 desat.
- Consider RT and/or MD to be present during PT session
Settings: Pre-set vs. Actual
FiO2
- 60% or LESS==== GREEN LIGHT FOR ALL THERAPY
- >60%===YELLOW LIGHT FOR BASIC ADL/BED EX’S—> CAUTION
Settings: Pre-set vs. Actual
PEEP
<10 cmH2O ===
GREEN LIGHT FOR ALL THERAPY
Settings: Pre-set vs. Acute
PEEP
>10 cmH20 ====
YELLOW LIGHT FOR IN BED EX’S AND OOB
Settings: Pre-set vs. Actual
PEEP
- <10cmH2O=== GREEN LIGHT ALL THERAPY
- >10cmH2O=== YELLOW LIGHT for IN BED EX’S and OOB
Settings: Pre-set vs. Actual
Respiratory Rate (Pt’s Actual)
<30 bpm====
GREEN LIGHT FOR ALL THERAPY
Settings: Pre-set vs. Actual
Respiratory Rate (Pts Actual)
>30 bpm ===
YELLOW LIGHT FOR IN BED EX’S AND OOB
Settings: Pre-set vs. Actual
Respiratory Rate (Pt’s Actual)
- <30 bpm===GREEN LIGHT
- >30 bpm===YELLOW LIGHT FOR IN BED EX’S AND OOB
Settings: Pre-set vs. Actual
Tidal Volume (VT)
- Be cognizant of pts Actual VT vs. Set VT
- *IF pt unable to maintain VT’s AND desat’ing during PT—> HOLD further therapy and consult w/ MD’s and RT’s for possible changes in vent. settings
Settings: Pre-set vs. Actual
Alarms
LOW Pressure vs. HIGH Pressure
Explain LOW PRESSURE
- Pt disconnects, circuit leaks/airway leaks
Settings: Pre-set vs. Actual
Alarms
Low Pressure vs. High Pressure
Explain HIGH PRESSURE
- Pt coughs
- Secretions in airways
- Pt biting the tubing
- DECd lung compliance
- INC airway resistance
- Bronchospasm
- Pt fighting the vent
Minute Ventilation (VE)==>
RR*VT
Mech. Vent settings shown
- Mode
- A/C
- FiO2
- PEEP
- fTOT
- VT
- Alarm Settings
- VE (MIN. Vent==RR*VT)
Mech. Vent Settings
shown
- Mode
- S/T
- FiO2
- PEEP
- RR
- VT
- Alarm Settings
- VE (Min. Vent==RR*VT)
PT Considerations w/ pts on Mech. Vents or Tubes
4 things (see pic):
- Set clear communication and expectations and provide TLC
- Inspect airways and note pos’s of ET tube @ START and END of ea. session
- Try not to pull it out! (*ESP the ET tube)
- If you are unable to monitor pt, the vitals, AND MV readings……ask nurse to help you
Pt enters hospital w/ severe medical condition OR worsening pulmonary status…..
Flowchart
Passy-Muir Valve
Cap on the end of the Tracheostomy tube
*For TALKING!!!
