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Patient Management Exam 3 Mix

Terms in this set (21)

What is BiPAP?
An airway pressure strategy that applies two different pressures, one on inspiration (IPAP) and one on expiration (EPAP).
What is IPAP?
The pressure applied to the inspiratory phase of the respiratory cycle.

Similar to pressure support
What is EPAP?
The pressure applied to the expiratory phase of the respiratory cycle.

Similar to PEEP
What is ramp?
A function found on some BiPAP machines that slowly increases both IPAP and EPAP over a period of time.

It is helpful in increasing patient comfort and decreasing the amount of time to fall asleep.
What is rise time?
A function found on some BiPAP machines that slopes the initial phase of inspiration (for every breath)

It is more like physiological breathing.
What is % I time?
A percentage of the total cycle time for inspiration.
What are the indications for BiPAP support?
*Nocturnal hypo-ventilation (sleep apnea)

*Non-invasive ventilation

*Refractory hypoxemia with normal ventilation

*Neuromuscular disease, restrictive lung disease, and chronic ventilatory insufficiency
Why would BiPAP be used in patients with neuromuscular disease, restrictive lung disease, and chronic ventilatory insufficiency?
1. To decrease the work of breathing

2. Increase/prolong quality of life
What are the contraindications and patient limitations for BiPAP?
Absolute Contraindication:
1. Untreated significant pneumothorax

Other relative contraindications:
1. Hypovolemia
2. Increased intracranial pressure or closed head injury
3. Unilateral lung disease
4. Pulmonary hyperinflation (emphysema, asthma)
5. Recent lung or sinus surgery
6. Claustrophobic patient
How can you determine pressure support?
The difference between IPAP and EPAP
What does changing EPAP effect?
Changing EPAP effects the volume delivered because a decrease in pressure support may occur.
What is the difference between a simple BiPAP machine used for nocturnal hypoventilation and a true non-invasive ventilator?
A non-invasive ventilator has a graphics package and a O2 blender so that the sensitivity is not affected by a change in the FiO2
What is the most effective way to improve ventilation with NIPPV?
Increase the "Delta P"
A 38 year old male patient admitted for CHF and Pulmonary edema presents to the ICU with the following.

ABG results show:

PH 7.48
PaCO2 28
PaO2 48
HCO3 23
BE +1
SaO2 82.8%
FiO2 1.0 NRB

The respiratory therapists assesses the patient and finds:

HR 104 Normal sinus tach.
RR 40
Neurologic Alert and Oriented X3
Lung Sounds bilateral wheeze

What mode of ventilation is most appropriate?
BiPAP with a full face mask
What would improve oxygenation in a patient being managed with non-invasive ventilation?
Increasing the EPAP
A patient is being treated for Obstructive Sleep Apnea (OSA) at home with BiPAP settings of 18/8. The patient is not comfortable initially at night because of nasal pressure and cannot fall asleep. What would you recommend?
Switch to a machine that has a ramp function
What is the normal range of Blood Urea Nitrogen?
10-20 mg/dl
What is a normal blood creatinine level?
.7-1.5 mg/dl
What is the greatest concern in ventilating non-compliant lungs?
High ventilating pressures causing pneumothorax
Among the potential adverse effects of mechanical ventilation, which is of greatest concern in the patient with a closed head injury?
Increased ICP due to decreased venous return
What is the greatest concern with a hypovolemic patient undergoing positive pressure ventilation?
The possibility of "shutting down" left sided preload
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