intermittent positive pressure breathing
therapy assisting patients in breathing utilizing a mask connected to a ventilator that introduces a positive pressure to the lungs.
Physiologic effects of IPPB
acts as a mechanical bronchodilator, Increases MAP, Increases Vt, decreases WOB, Alters I:E ratio, Alters cerebral blood flow.
Corrective actions for IPPB patients that HYPER-ventilate
Coach the patient to breath slowly and to pause between breaths.
Indications for IPPB
Increased WOB, HYPO-ventilation (^PaCO2), increased Raw, pulmonary edema, weaning from mechanical ventilation, inadequate cough, treatment of atelectasis.
Hazards of IPPB
Hyperventilation (reduced PaCo2 leads to vasoconstriciton), hyperoxygenation of COPD patients (knock out the drive to breath), Decreased cardiac output, Increased ICP (closed head injuries/CNS diseases), Pneumothorax, Hemoptysis, Gastric distention, nosocomial infections.
Powersource for the Bennet AP-5
the IPPB unit which is powered by AC, and the flow is powered by a compressor.
Powersource for the Bennet PR-2
the IPPB unit which is powered pneumatically, and the flow is powered by a compressor.
Factors which can increase Vt with IPPB
Decreased Raw, Increased static compliance, Increased inspiratory pressure.
Factors which can decrease Vt with IPPB
Increased Raw, Decreased static compliance, Decreased inspiratory pressure.
Recomended sensitvity to cycle IPPB in cmH20
Patient has to generate between (-0.5 to -2.0 cmH2o) to cycle intermittent positive pressure breathing therapy
Goals of Incentive Spirometry
to prevent atelectasis, treat preexisting atelectasis, improve cough mechanism, used pre-operatively to strengthen and mobilize secretions in the airway. most cost effective device
How should an IPPB treatment be modified for a closed head injury?
by increasing the Ti (flow), and/or decreasing (PIP) Peak Inspiratory Pressure. (increasing Ve by ƒ not PIP(Vt))
"High risk Infant" defined..
any newborn or young infant who has a high probability of manifesting in childhood a sensory, motor, cognitive/language or social deficit (Domains). SHOULD BE FOLLOWED FOR 1 YEAR in a high risk clinic.
Maternal factors of "High Risk Infant"....
.....Age <16 or >35. DM, history of ETOH, Hypertensive, Lack of prenatal care, previous C-section, sepsis, previous birth with respiratory anomolies.
factors of "High-risk infant", other than maternal
Premature <38 weeks gestation; post-mature > 42 weeks gestation (risk of meconium aspiration); prolapsed cord; prolonged labor; abnormal presentation.
Ballard Scoring system
The most common scoring system used to determine gestational age of a newborn.
APGAR scoring system
assessment of 5 characteristics of the newborn: Appearance-color, Pulse-heart rate, Grimace-irritability, Activity-muscle tone, and Respirations-respiratory effort. The lower- the more severe.
APGAR scale of severity
APGAR 7 - 10:dry, warm, clear airway w/bulb syringe; APGAR 4 - 6: indicates moderate asphyxia, stimulate and administer O₂; APGAR 0 - 3:severe asphyxia, immediate resuscitation w/ventilatory assistance
Silverman scoring system
system of assessment to determine severity of respiratory distress. The higher the number the more severe
Normal values for newborns
Respiratory rate:40 - 60 bpm; Heart rate 130 - 150 bpm; Blood presuure 60 - 90 mmHg / 30 - 60 mmHg; Temperature 97.6° ±1°(axillary), 99.6° ±1°(rectally)
Signs and symptoms of hypoxemia
Dyspnea, tachycardia, cyanosis, headache, change of mental status, slight hyperventilation.
Complications of FiO2 > 0.60
Increased O2 levels can wash out nitrogen reducing surfactant production (atelelctasis), high O2 can lead to increased O2 free radicals (lung tissue toxicity), increased FiO2 reduces cillia activity (reduced mucocilliary activity), premature infants exposed to high FiO2 (ROP)
Etiology of Anemic Hypoxia
Decreased hemoglobin, CO poisoning, Excessive blood loss, increased MetHemoglobin levels, Iron deficiency.
PCWP (also called PAWP and PAOP)
an indirect measurement of pressure in the heart's left atrium.
Directly monitored during pulmonary catheterization
oxygen analyzer which records the potential difference in chemical current, results 10 - 30 Secs