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S2 Mechanical Vent 1
Chapter 7 Noninvasive Positive Pressure Ventilation
Question | Answer |
---|---|
noninvasive positive pressure ventilation provides | assisted ventilation without an artificial airway |
NPPV may be used to assist patients with | obstructive sleep apnea and acute ventilatory failure |
NPPV provides ventilation via | the patients nose or mouth without an artificial airway |
NPPV is | Noninvasive positive pressure ventilation |
NPPV is ventilation without | an artificial airway |
NPPV may be used as | CPAP or bilevel PAP |
CPAP is | Continuous positive airway pressure |
CPAP uses | positive airway pressure during spontaneous breaths |
CPAP does not use | mechanical breaths |
CPAP is active | when IPAP = EPAP |
Bilevel PAP is | Bilevel positive airway pressure also known as BiPAP |
BiPAP provides | IPAP and EPAP |
During BiPaAP CPAP is active | when IPAP = EPAP |
IPAP is | Inspiratory positive airway pressure |
IPAP controls | peak inspiratory pressure during inspiration |
EPAP is | Expiratory positive airway pressure |
EPAP controls | end-expiratory pressure |
EPAP is used as CPAP when | IPAP = EPAP |
EPAP is used as PEEP when | IPAP > EPAP |
PEEP is | Positive end-expiratory pressure |
PEEP is PAP at | end -expiratory phase |
PEEP is used with | mechanical breaths |
IPAP is the level of airway pressure | during inpiratory phase only |
EPAP is the level of airway pressure | during expiratory phase only |
The degree of ventilation is directly related to the | IPAP level |
HIGHer IPAP level would result in | Larger tidal volume and minute ventilation |
The level of IPAP and EPAP can be titrated according to | a patients oxygenation and ventilation needs |
the two benifits of NPPV are | improvement of PO2 and PCO2 |
CPAP does not include | any mechanical breaths |
CPAP is the treatment of choice for | obstructive sleep apnea without significant CO2 retention |
OSA is caused by | severe airflow obstruction during sleep |
CPAP provides | positive airway pressure during the entire sontaneous breath |
During CPAP the work of breathing is | entirely assumed by the patient |
CPAP should be used with care and | close monitoring of the patient as it is not effective in apnea due to neuromuscular causes |
Sleep apnea is defined as | a temporary pause in breathing that lasts at least 10 seconds during sleep |
Sleep apnea is caused by | Air Flow obstruction (OSA) or a loss of neurologic breathing effort (central sleep apena), or a combination of these two conditions (mixed sleep apnea) |
Indications for CPAP | Obstuctive sleep apnes |
Contraindications for CPAP | Apnea due to neuromuscular causes, progressive hypoventilation, fatigue of respiratory muscles, facial trauma, claustrophobia |
Apnea index is | average number of apneas in each hour of sleep during a test |
hypopnea is | reduction in airflow for 10 or more seconds that is at least 50% below an estimated baseline amplitude. |
hypopnea is usually associated with | an oxygen desaturation or a pulse alteration |
apnea-hypopnea index is | average number of apnea and hypopnea in each hour of sleep during a test |
desaturation index is | average number of oxygen desaturations of 4% or more from baseline in each hour of sleep during a test |
treatments for OSA include | oral applications such as prosthetic mandibular advancement, surgical interventions such as tonsillectomy and uvulopalatopharyngoplasty for upper obstructions, and weight reduction gastric surgery for morbidly obese patients. |
Risk factors for OSA include | History of snoring and witnessed apneas, obesity, increased neck circumference, hypertension, and family history of OSA |
OSA major clinical signs and symptoms are | snoring, daytime sleepiness, restless sleep, morning fatigue, and headaches. |
If untreated OSA can lead to | hypertension, left and right ventricular hypertrophy, sudden cardiovascular death, and increased risk for brain infarction |
BiPAP has how many pressure levels | 2 |
CPAP has how many pressure levels | one |
PEEP is defined as | an airway pressure that is above 0 cm H2O at end-expiration |
Two indications for bilevel PAP are | accute respiratory failure and acute hypercapnic exacerbations of COPD |
BiPAP differes from CPAP in that | BiPAP has two pressure levels, whereas CPAP has only one |
In BiPAP has an IPAP setting that provides | mechanical breaths |
BiPAP has an EPAP setting that | functions as positive end expiratory pressure |
The most common criteria for the determination of acute respiratory failure | blood gas results that typically show partially compensated respiratory acidosis with moderate hypoxemia |
Patients that are not candidates for NPPV are | unable to use or tolerate nasal or facial mask |
Indications for NPPV | reduction of respiratory workoad in obesity, acute respiratory failure, acute hypercapnic exacerbations of COPD |
Contraindications for NPPV | Apnea, unalbe to handle secretions, facial trauma, claustrophobia |
Interfaces for NPPV | Nasal mask, facial mask, nasal pillows |
Nasal mask is | a mask that covers only the nose |
A minor leak in a nasal mask is | considered acceptable. |
When a leak in a nasal mask is significant | a facial mask should be considered |
A Facial mask is | a mask that covers the nose and mouth |
Potential problems when using a facial mask include | Regurgitation and aspiration |
Advantagles of using a Nasal mask | Comfort, patient compliance |
Disadvantages of using a nasal mask | gas leaks, nasal dryness or drainage |
advantage of using the facial mask | good seal |
disadvantages of using a facial mask | claustrophobia, patient noncompliance, regurgitation and aspiration, asphyxiation in power or gas outage, alarm and monitor may be necessary |
IPAP is an | airway pressure above 0 cm H2O during inspiration |
EPAP is an | airway pressure that is above 0 cmH2O at end expiration |
The initial CPAP setting is started at | 4 cmH2O and titrated to a desired endpoint |
What is RAMP | the starting pressure is set low and gradually increases over time (up to 45 minutes) until the desired pressure is reached. |
RAMP is ideal for | patients who may have trouble tolerating a sudden onset of high pressure |
What is C-FLEX | a method of delivering aCPAP for the treatment of OSA |
The initial BiPAP pressures are started at | 8 cm H2O (inspiratory, and 4 cm H2O expiratory pressure and titrated to a desired endpoint. |
What is Bi-Flex | A method of delvering bilevel PAP in which the airflow during inhalation and exhalation is "softened" this makes breathing more natural and comfortable for the patient |
titration endpoints of IPAP and EPAP during bilevel PAP do not include | PvO2 |
NPPV can not provide | positive end expiratory pressure (PEEP) |