Noninvasive ventilation: Difference between revisions
No edit summary |
No edit summary |
||
| Line 15: | Line 15: | ||
==Indications== | ==Indications== | ||
*CHF | |||
*COPD | |||
*Asthma | |||
*OSA | |||
*Pulmonary edema | |||
*Pneumonia | |||
==Contraindications== | ==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== | ==Procedure== | ||
| Line 34: | Line 34: | ||
#Position the patient in a 30-90° upright position. | #Position the patient in a 30-90° upright position. | ||
#Apply the mask. | #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. | #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. | #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. | #Continue close monitoring. | ||
# | #*A doctor, nurse, or respiratory therapist should be with the patient at all times during BPAP/CPAP use. | ||
==Complications== | ==Complications== | ||
Revision as of 18:42, 14 May 2015
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
Source
EMcrit Podcast 19