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CPAP
BiPAP
AVAPS
Making Changes & Alarms
Free For All
100
#1 Indication for CPAP
What is OSA?
100
IPAP improves.... EPAP improves...
What is IPAP improves VENTILATION EPAP improves OXYGENATION
100
AVAPS would be defined as which type of ventilation (pressure vs volume).
What is PRESSURE--the pressure is sent BREATH BY BREATH to achieve a targeted Vt.
100
To improve ventilation which Bipap setting needs changed.
What is IPAP (and also PS--widden the difference between IPAP and EPAP)?
100
6 complications of NIV.
What is SEE TABLE 19-5 in chapter 19.
200
4 results/benefits of CPAP
What is 1. Increased FRC 2. Increased Oxygenation 3. Decreased Periods of Obstructive Apnea 4. Better & More Restful Sleep
200
3 Modes of BiPAP.
What is Spontaneous: IPAP and EPAP for every breath--not set rate. Spont/Timed: IPAP & EPAP for every breath with a set backup rate. Timed: IPAP & EPAP ONLY on set rate.
200
Settings for AVAPS
What is: FiO2: 21-100% wean to keep >90% Target Vt: 7-10ml/kg RR: 8-20bpm (initially 12-14bpm) EPAP: 5-10cmH2O Min Pressure: 8-12cmH2O (or higher) Max Pressure: Highest Pressure willing to ventilate a patient (normal 15-25cmH20--pt dependent).
200
The 2 Bipap settings that can be changed to improve oxygenation.
What is FiO2 and EPAP.
200
#1 contraindications for NIV.
What is inability to protect airway. 5 ways to identify a patient who can't protect airway???
300
Definition of CPAP.
What is the application of pressure throughout the inspiration and expiration phase of the breath?
300
Explain Rise Time
What is the portion of Inspiratory Time used to reach IPAP. The short the amount the fast the breath will be delivered (Draw an example of the difference between 0.2 seconds and 0.4 second rise time).
300
Benefit over Bipap
What is AVAPS will ensure a relatively consistent Vt independent of changing lung characteristics (Changes in compliance and Raw). Does so by adjusting the IPAP pressure breath by breath.
300
EPAP should be greater than _________cmH2O to prevent _____________.
What is 4cmH20 re-breathing CO2
300
3 interfaces used to deliver NIV.
What is... Nasal Mask Full/Total Mask Nasal Pillows
400
Patient CPAP settings.
What is 1. FiO2: 21-100% or Liter flow: 1-15Lpm (keep SpO2 >90%) 2. CPAP Pressure: 5-20cmH2O
400
Initial BiPAP settings for a 5'8" female with the following ABGS: 7.31/71/50/25 on 15L NRB. She is breathing 30 bpm.
What is FiO2: 100% RR: 12bpm (functions as backup RR) IPAP: 10cmH2O (Adjust to get a Vt: 462-660m). EPAP: 5cmH2O Itime: 1sec (Adjust for patient comfort) Rise Time: 0.2 sec (adjust for patient comfort)
400
5 results of AVAPS.
What is 1. Improved Ventilation 2. Improved Oxygenation 3. Increased FRC 4. Preventing the need for invasive ventilation 5. Improved patient comfort & compliance.
400
Normal alarm settings for a patient on Bipap of IPAP: 10 EPAP: 5 Itime: 1sec RR: 14bpm (total RR: 24bpm)
What is High Pressure: 20cmH2O Low Pressure: 7cmH2O Low VE: 3lpm Apnea: 30 seconds High RR: 34bpm Low RR: 12bpm
400
6 way to improve a patient's tolerance of NIV.
What is... 1. More frequent smaller meals. 2. Medications to take the edge off 3. Sitting up in semi-fowler position 4. Give breaks for 5-10 minutes if tolerates 5. Tell them when the next break will be. 6. Oral cares, brush teeth, and wash face.
500
CPAP is also indicated in....
What is Cardiogenic Pulmonary Edema? Helps to push the fluid back into the vasculature.
500
6 selection criteria for using NIV and their parameters in the acute setting.
What is pH: 7.28-7.35 PaCO2: 45-80mmHg PaO2/FiO2: <200 Patient Tolerance (ability to wear a mask) Vital Signs RR: >24bpm and increased distress Disease Reversibility HELPFUL TIP: Create a patient scenario for a patient who does not meet the selection criteria and requires more support than NIV.
500
How a therapist determines the Min P and Max P.
What is pressure needed to deliver a Vt of 7-10ml/kg?
500
A patient on Bipap of 12/5 RR: 12 (total RR: 20bpm), Itime: 1sec, FiO2: 80% has the following ABGS: 7.33/60/62/25. Changes to make...
What is Increase IPAP to 14-15cmH2O. Increase EPAP: 7cmH2O. ONLY 1 CHANGE FOR VENTILATION & 1 CHANGE FOR OXYGENATION!!!
500
2 ways to discontinue NIV.
What is 1. Increasing Break Time 2. Decreasing Pressures