Week 9

Question 1

What are the aims of non-invasive ventilation?

Answer 1

improve gas exchange, offload respiratory muscles, avoid need for invasive ventilation, maximise QOL, improve sleep duration & quality and enhance airway clearance, atelectasis management and exercise with physiotherapy

Question 2

What are the different NIV settings typically used?

Answer 2

IPAP- inspiratory positive airway pressure (pushing air into the lungs)

EPAP- expiratory positive airway pressure (splints airways open)

PS- pressure support

Question 3

When setting the ratio of IPAP to EPAP, which should always be higher?

Answer 3

IPAP always higher than EPAP

Question 4

What are the different NIV modes typically used?

Answer 4

spontaneous, spontaneous/timed, timed, CPAP (EPAP alone)

Question 5

What are some contraindications to NIV?

Answer 5

cardiovascular instability, airway obstruction, respiratory/facial trauma/burns, severe haemoptysis, undrained pneumothorax, seriously depressed level of consciousness

Question 6

What are some precautions to NIV?

Answer 6

GCS <9, inability to clear secretions, facial pressure areas, GOR

always have a contingency plan in place to intubate if necessary

Question 7

Describe an oropharyngeal airway.

Answer 7

short plastic tube from mouth to pharynx

keeps airway open and can facilitate suction

inserted by medical, nursing or PT through a sideways then twisting motion to avoid scraping the roof of the patients mouth

Question 8

Describe a nasopharyngeal airway.

Answer 8

short plastic tube from nose to pharynx

keeps airways open and can facilitate suction

inserted by medical, nursing or PT with lubricant

Question 9

What are some precautions to using a nasopharyngeal airway?

Answer 9

nasal/facial fractures, CSF leak or torn dura (is bacteria enters CSF it can cause meningitis)

anticoagulant therapy, hypotension

Question 10

What are the types of tubes used for intubation?

Answer 10

endotracheal tube (ETT)
nasotracheal tube (NTT)
tracheostomy

Question 11

Compare the benefits of an endotracheal tube vs a nasotracheal tube.

Answer 11

ETT is a larger tube so less likely to become blocked by secretions, however it can damage patients teeth and be occluded by biting, and is less tolerated by patients

NTT makes oral hygiene easier to maintain and is easier to insert, however becomes blocked more easily due to smaller tube size and can lead to sinus infection and nose bleeds

Question 12

What is the function of the cuff on a intubation tube?

Answer 12

to prevent aspiration of gastrointestinal contents, provide a good seal for ventilation and prevents movement of the tube

Question 13

What is the purpose of a minitracheostomy?

Answer 13

a tracheostomy that is used in paediatrics the same as a traditional tracheostomy, however also used in adults to facilitate suction while the patient maintains their own airway

Question 14

What size suction catheter is used for a minitracheostomy?

Answer 14

size 8 or 10

Question 15

When is suction required?

Answer 15

when a patient is intubated, unconscious and/or is unable to cough & expectorate effectively with retained secretions

Question 16

What are some precautions to suction?

Answer 16

pulmonary oedema
haemoptysis (treat bleed before continuing)
respiratory burns (use a soft catheter)
head injuries (risk of increasing intracranial pressure)
high levels of PEEP or FiO2 (as need for removal of ventilator prior to suction)
severe infection (as a matter of infection control)

Question 17

What are closed suction systems?

Answer 17

a type of ventilator that allows suction to occur without disconnecting the patient from their oxygen

almost 100% use in health care settings these days

Question 18

What is a Yankeur suction tip used for?

Answer 18

it is a oral suctioning tool that allows suctioning from the mouth/back of the throat (do not use it past here as most people will gag)