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 | ||
* | *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]] | |||
*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== | |||
#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. | |||
== | ==Complications== | ||
*Skin irritation | |||
*Nasal bridge pain | |||
*Mucosal dryness | |||
*Eye irritation | |||
*Gastric distention | |||
*Decreased cardiac output | |||
*Barotrauma (rarely) | |||
==See Also== | ==See Also== | ||
{{Mechanical ventilation pages}} | |||
[[Category: | ==References== | ||
[[Category: | <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
- 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.
Complications
- Skin irritation
- Nasal bridge pain
- Mucosal dryness
- Eye irritation
- Gastric distention
- Decreased cardiac output
- Barotrauma (rarely)
See Also
Mechanical Ventilation Pages
- Noninvasive ventilation
- Intubation
- Mechanical ventilation (main)
- Miscellaneous