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Medicine Notes - Clinical Procedures - Non invasive Ventilation (BiPAP and CPAP)
CPAP
Medicine notes- Clinical procedures- Non invasive ventilation
There are two different forms of non invasive ventilation. There are known as CPAP or continuous positive airway pressure and BiPAP or known as bilevel positive airway pressure.
Non invasive ventilation is considered in situation where the patient unable to breath normally with low level of oxygenation. Type 1 respiratory failure obstructive pulmonary edema, lobar or bibasal pneumonia and cardiogenic pulmonary edema as well as weaning are the common indication for the needs of continuous positive airway pressure ( CPAP).
Bilevel positive airway pressure /BiPAP are considered if the patient suffer from type 2 respiratory failure, respiratory muscle weakness, weaning or cardiogenic pulmonary edema.
CPAP presents in 2 forms. They are low flow vision and the BiPAP vision. CPAP consist circuit of oxygen and humidification, mask, hood, PEEP valve ( 5 -10cmH20 ), shoulder straps, T piece, head strap, high flow generator and blow off safety valve ( 10cmH20 above PEEP. ( PEEP is known as positive end expiratory pressure
BiPAP consists of humidification, head strap, ( face mask or nasal mask or nasal pong), ventilation circuit, entrained oxygen and ventilator ( NIPPY 1/2/3/3+ )
It is important to document a few things while establishing the non invasive ventilation. Non invasive ventilation should only be performed with experienced operator. Few documents such as oxygen prescription, ventilation prescription charts, the pressure ceiling value, fraction of the inspired oxygen and arterial blood gases reports should be prepared.
Before beginning non invasive ventilation, the patient is observed for any signs that may contraindicate not invasive ventilation. Certain factors may contraindicate the use of non invasive ventilation. The contraindications are hypotension, life threatening epistaxis, middle ear infection, active tuberculosis, fracture of the face, sinusitis, cardiac arrhythmias, head injury acute in onset, undrained pneumothorax, proximal tumor of the lung and bullous pulmonary lung disorders.
In CPAP, the initial step is to choose the PEEP value to apply ( 5- 10 cm H20). The patient need to wear mask with or without T piece. The PEEP valve will be inserted to the mask. For safety reason, blow off valve is attached with oxygen circuit and humidification. The flow rate need to be adjusted so that the PEEP valve will remain open for a small distance and never closed. The inspired oxygen level is set. Alarm may be set on the ventilator. The patient response, work of breathing , oxygen saturation, pH, partial pressure of oxygen and partial pressure of carbon dioxide are vital in titrating the oxygen and PEEP requirement.
In BiPAP, the initial step is to choose the interface available. The interface include the nasal pong, nasal mask or facial mask. The expiratory positive airway pressure should be 4 cm H20 while the inspiratory positive airway pressure should be 12 cm H20. The aim of these pressures are to reduce the respiratory rates, normalizes the arterial blood gases and work of breathing with minimal pressure. The pressures may be increased based on the patient’s partial pressure of oxygen, partial pressure of carbon dioxide, pH and agreement of the multidisciplinary team. Alarm need to be set on the ventilator. The patient ‘s oxygen saturation, partial pressure of oxygen and partial pressure of carbon dioxide will influence the need to titrate the oxygen and pressure. The inspiratory and expiratory time are set. Respiratory rates need to be continuously monitored.
The common complication of non invasive ventilation ( CPAP or BiPAP) are aspiration of the vomitus or secretion, hypotension, pulmonary barotrauma, neck pressure sores, swallowing air, retention of carbon dioxide mostly happen if small tidal volume against high PEEP and decrease cardiac output and swollen abdomen.
References
1.Masip, Josep. “Non-invasive Ventilation.” Heart Failure Reviews 12, no. 2 (June 1, 2007): 119–124. doi:10.1007/s10741-007-9012-7.
2.S, Nava, Navalesi P, and Carlucci A. “Non-invasive Ventilation.” Minerva Anestesiologica 75, no. 1–2 (December 2008): 31–36.
3.C, Hörmann, Baum M, Putensen C, Mutz Nj, and Benzer H. “Biphasic Positive Airway Pressure (BIPAP)--a New Mode of Ventilatory Support.” European Journal of Anaesthesiology 11, no. 1 (January 1994): 37–42.
4.Engleman, Heather M., Nima Asgari-Jirhandeh, Andrew L. McLeod, Crichton F. Ramsay, Ian J. Deary, and Neil J. Douglas. “Self-reported Use of Cpap and Benefits of Cpap Therapy : A Patient Survey.” CHEST Journal 109, no. 6 (June 1, 1996): 1470–1476. doi:10.1378/chest.109.6.1470.
There are two different forms of non invasive ventilation. There are known as CPAP or continuous positive airway pressure and BiPAP or known as bilevel positive airway pressure.
Non invasive ventilation is considered in situation where the patient unable to breath normally with low level of oxygenation. Type 1 respiratory failure obstructive pulmonary edema, lobar or bibasal pneumonia and cardiogenic pulmonary edema as well as weaning are the common indication for the needs of continuous positive airway pressure ( CPAP).
Bilevel positive airway pressure /BiPAP are considered if the patient suffer from type 2 respiratory failure, respiratory muscle weakness, weaning or cardiogenic pulmonary edema.
CPAP presents in 2 forms. They are low flow vision and the BiPAP vision. CPAP consist circuit of oxygen and humidification, mask, hood, PEEP valve ( 5 -10cmH20 ), shoulder straps, T piece, head strap, high flow generator and blow off safety valve ( 10cmH20 above PEEP. ( PEEP is known as positive end expiratory pressure
BiPAP consists of humidification, head strap, ( face mask or nasal mask or nasal pong), ventilation circuit, entrained oxygen and ventilator ( NIPPY 1/2/3/3+ )
It is important to document a few things while establishing the non invasive ventilation. Non invasive ventilation should only be performed with experienced operator. Few documents such as oxygen prescription, ventilation prescription charts, the pressure ceiling value, fraction of the inspired oxygen and arterial blood gases reports should be prepared.
Before beginning non invasive ventilation, the patient is observed for any signs that may contraindicate not invasive ventilation. Certain factors may contraindicate the use of non invasive ventilation. The contraindications are hypotension, life threatening epistaxis, middle ear infection, active tuberculosis, fracture of the face, sinusitis, cardiac arrhythmias, head injury acute in onset, undrained pneumothorax, proximal tumor of the lung and bullous pulmonary lung disorders.
In CPAP, the initial step is to choose the PEEP value to apply ( 5- 10 cm H20). The patient need to wear mask with or without T piece. The PEEP valve will be inserted to the mask. For safety reason, blow off valve is attached with oxygen circuit and humidification. The flow rate need to be adjusted so that the PEEP valve will remain open for a small distance and never closed. The inspired oxygen level is set. Alarm may be set on the ventilator. The patient response, work of breathing , oxygen saturation, pH, partial pressure of oxygen and partial pressure of carbon dioxide are vital in titrating the oxygen and PEEP requirement.
In BiPAP, the initial step is to choose the interface available. The interface include the nasal pong, nasal mask or facial mask. The expiratory positive airway pressure should be 4 cm H20 while the inspiratory positive airway pressure should be 12 cm H20. The aim of these pressures are to reduce the respiratory rates, normalizes the arterial blood gases and work of breathing with minimal pressure. The pressures may be increased based on the patient’s partial pressure of oxygen, partial pressure of carbon dioxide, pH and agreement of the multidisciplinary team. Alarm need to be set on the ventilator. The patient ‘s oxygen saturation, partial pressure of oxygen and partial pressure of carbon dioxide will influence the need to titrate the oxygen and pressure. The inspiratory and expiratory time are set. Respiratory rates need to be continuously monitored.
The common complication of non invasive ventilation ( CPAP or BiPAP) are aspiration of the vomitus or secretion, hypotension, pulmonary barotrauma, neck pressure sores, swallowing air, retention of carbon dioxide mostly happen if small tidal volume against high PEEP and decrease cardiac output and swollen abdomen.
References
1.Masip, Josep. “Non-invasive Ventilation.” Heart Failure Reviews 12, no. 2 (June 1, 2007): 119–124. doi:10.1007/s10741-007-9012-7.
2.S, Nava, Navalesi P, and Carlucci A. “Non-invasive Ventilation.” Minerva Anestesiologica 75, no. 1–2 (December 2008): 31–36.
3.C, Hörmann, Baum M, Putensen C, Mutz Nj, and Benzer H. “Biphasic Positive Airway Pressure (BIPAP)--a New Mode of Ventilatory Support.” European Journal of Anaesthesiology 11, no. 1 (January 1994): 37–42.
4.Engleman, Heather M., Nima Asgari-Jirhandeh, Andrew L. McLeod, Crichton F. Ramsay, Ian J. Deary, and Neil J. Douglas. “Self-reported Use of Cpap and Benefits of Cpap Therapy : A Patient Survey.” CHEST Journal 109, no. 6 (June 1, 1996): 1470–1476. doi:10.1378/chest.109.6.1470.
