Ventilation support Flashcards
CI to BIPAP/NIV
airway obstrcution
pneumothoarx
recent upper GI or facial surgery
facial or airway burns
use with caution in patients who are vomiting
/excess secreations/confused/drowsy
CPAP works how - just EPAP
continuous positive ariway ressure - splints open alveoli to improve oxygenation - opens collapsed bronchiols and alveoli useful in pulmonayr oedema and obstrutive sleep apnoea
bipap work how - 2 settings I and e pap
iPAP improves ventilation by increasing tidal volume and therfore CO2 clearance
Complications of NIV and what you can do
High intrathoracic pressure leading to:
Risk of pneumothorax (do a CXR before starting)
Risk of compression of great vessels causing decreased venous return and hypotension
F1 action: do a CXR prior to starting, ensure not hypovolaemic prior to starting/replace fluid alongside
NIV
Vomiting:
Stomach can be overinflated giving a risk of aspiration
Invasively ventilated patients have NG tubes placed to aspirate the stomach
F1 action: consider anti emetics
Mask issues:
Air leak is common
F1 action: make sure the mask fits properly and if not tighten it/speak to NIV/HDU nurses to do this
Not tolerated:
It’s bloody grim- imagine sticking your head out of a car window going at 70mph!
Hypoxic patients can often be confused
F1 action: can use small doses of opiates to reduce stress/discomfort, use comm skills, OR stop the
treatment and consider alternatives such as invasive ventilation, medical/conservative treatment or
palliation
bipap used when
COPD - certain criteria CO2 above 6.5 and ph below 7.35 RR OVER 23
NOT REPSONding to bronchodilators and controlled 02 therapy
neuromuscular disease
obesity hypoventilation syndrome
respiratry acidosis cause 5
Hypoventilation
Asthma
Pneumonia
COPD
CNS depressants
resp alk 3
Hyperventilation
Panic attack
Salicylate poisoning
metabolic acidosis 3
Diabetic ketoacidosis
Renal failure
Shock/hypoperfusion
metabolci alk
Prolonged vomiting
Diarrhoea
