Noninvasive ventilation: Difference between revisions

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==Background==
==Background==
===Mechanism of Action===
*Augments inspiratory/expiratory pressures throughout a spontaneous respiratory cycle.
**Recruits compressed alveoli to reduce atelectasis.
**Prevents small airway collapse during inspiration.
**Counteracts intrinsic PEEP (Positive End Expiratory Pressure).
**Decreased both preload and afterload in heart failure exacerbations.
**Improves lung compliance and V/Q matching.
**Decreases the work of breathing.
===CPAP vs. BPAP===
*CPAP = PEEP = EPAP
*CPAP = PEEP = EPAP
*BiPAP = PEEP + (pressure support = IPAP)
*BPAP = PEEP + (IPAP = Inspiratory Pressure Support)
**Note: BiPAP is a brand name of one of the BPAP machines. Both names are often used interchangeably.


==Indications==
==Indications==
#CHF
*[[CHF]]
#COPD
*COPD
#Asthma
*Asthma
#OSA
*OSA
#Pulmonary edema
*Pulmonary edema
#Pneumonia
*Pneumonia
 
==Contraindications==
*Obtunded patients
*Uncooperative patients
*Vomiting or inability to protect the airway (aspiration risk)
*Facial trauma or burns
*Facial, esophageal, or gastric surgery
*Poor mask fit
 
==Procedure==
#Prepare intubation equipment in case of BPAP/CPAP failure.
#Position the patient in a 30-90° upright position.
#Apply the mask.
#*Select the appropriately-sized mask.
#*Secure it in place by fastening the Velcro straps.
#*Note: Some experts recommend allowing the patient to get used to the mask first, PRIOR TO starting the positive airway pressures.
#Prepare the patient.
#*Patients will often require frequent coaching throughout this process.
#*In moderately anxious patients, consider a benzodiazepine or Ketamine to assist with patient-ventilator synchrony.
#Adjust the settings.
#*For BPAP, begin with an IPAP of 8-10 cm H2O and an EPAP of 2-4 cm H2O.
#*Gradually titrate upward IPAP and EPAP 1-2 cm every 5-15 minutes with a goal IPAP 10-16 cm H2O and EPAP of 8-10 cm H2O depending upon patient response.
#Continue close monitoring.
#*A doctor, nurse, or respiratory therapist should be with the patient at all times during BPAP/CPAP use.


==Settings==
==Complications==
#Failure of oxygenation
*Skin irritation
##Pulmonary Edema, PNA
*Nasal bridge pain
##Start PEEP 5 (up to 15)
*Mucosal dryness
###Recruits alveoli
*Eye irritation
###Improves V/Q mismatch
*Gastric distention
###Decreases preload/afterload
*Decreased cardiac output
#Failure of ventilation
*Barotrauma (rarely)
##Asthma, COPD
###When tire out unable to move air
##Need inspiratory pressure support
##Start pressure support 5 (up to 15)
##Consider PEEP 2-3 to overcome the mask


==See Also==
==See Also==
*[[Ventilation (Main)]]
{{Mechanical ventilation pages}}
*[[Ventilation (Settings)]]
*[[Ventilation (Weaning)]]
*[[Ventilation (Management)]]
 
==Source==
EMcrit Podcast 19


[[Category:Airway/Resus]]
==References==
[[Category:Pulm]]
<references/>
[[Category:Critical Care]]
[[Category:Pulmonary]]

Revision as of 12:38, 24 September 2016

Background

Mechanism of Action

  • Augments inspiratory/expiratory pressures throughout a spontaneous respiratory cycle.
    • Recruits compressed alveoli to reduce atelectasis.
    • Prevents small airway collapse during inspiration.
    • Counteracts intrinsic PEEP (Positive End Expiratory Pressure).
    • Decreased both preload and afterload in heart failure exacerbations.
    • Improves lung compliance and V/Q matching.
    • Decreases the work of breathing.

CPAP vs. BPAP

  • CPAP = PEEP = EPAP
  • BPAP = PEEP + (IPAP = Inspiratory Pressure Support)
    • Note: BiPAP is a brand name of one of the BPAP machines. Both names are often used interchangeably.

Indications

  • CHF
  • COPD
  • Asthma
  • OSA
  • Pulmonary edema
  • Pneumonia

Contraindications

  • Obtunded patients
  • Uncooperative patients
  • Vomiting or inability to protect the airway (aspiration risk)
  • Facial trauma or burns
  • Facial, esophageal, or gastric surgery
  • Poor mask fit

Procedure

  1. Prepare intubation equipment in case of BPAP/CPAP failure.
  2. Position the patient in a 30-90° upright position.
  3. Apply the mask.
    • Select the appropriately-sized mask.
    • Secure it in place by fastening the Velcro straps.
    • Note: Some experts recommend allowing the patient to get used to the mask first, PRIOR TO starting the positive airway pressures.
  4. Prepare the patient.
    • Patients will often require frequent coaching throughout this process.
    • In moderately anxious patients, consider a benzodiazepine or Ketamine to assist with patient-ventilator synchrony.
  5. Adjust the settings.
    • For BPAP, begin with an IPAP of 8-10 cm H2O and an EPAP of 2-4 cm H2O.
    • Gradually titrate upward IPAP and EPAP 1-2 cm every 5-15 minutes with a goal IPAP 10-16 cm H2O and EPAP of 8-10 cm H2O depending upon patient response.
  6. Continue close monitoring.
    • A doctor, nurse, or respiratory therapist should be with the patient at all times during BPAP/CPAP use.

Complications

  • Skin irritation
  • Nasal bridge pain
  • Mucosal dryness
  • Eye irritation
  • Gastric distention
  • Decreased cardiac output
  • Barotrauma (rarely)

See Also

Mechanical Ventilation Pages

References