NIPPV

Question 1

When would you use NIPPV?

Answer 1

Anything w/high WOB

1. CHF
2. Asthma
3. COPD
4. Bad response to extubating

Question 2

What 2 things should you monitor from the PT for NIPPV?

Answer 2

1. WOB; think about their RR
   - don’t wait for resp. failure
2. CNS status

Question 3

How do you prevent intubation?

Answer 3

1. Treat underlying cause, but focus on protecting resp. drive
2. Maintain fluid balance
3. Antibiotics if needed

Question 4

What are prosts upper limits?

Answer 4

16/4; pressure support upper limit is 12.

• remember the delta is more important when setting ipap/epap.

Question 5

How often should you titrate changes for NIPPV?

Answer 5

3-5 minutes

Question 6

What physiological effects does IPAP have?

Answer 6

1. Reduces WOB
2. Relives resp. muscle fatigue.
3. Augments pts own spont. efforts -> Improves Vt

Question 7

Does IPAP or EPAP improve oxygenation?

Answer 7

EPAP; it helps maintain the airway open and improves oxygenation by preventing airway collapse during exhalation.

Question 8

Does IPAP or EPAP improve ventilation?

Answer 8

IPAP; it increases the patients tidal volume by providing PPV during inspiration.

• helps overcome resistances in airways and improves the dist. of air throughout the lungs.

Question 9

When looking at the Pt. what are things you can observe as indications for NPPV?

Answer 9

1. Accessory muscle use.
2. Paradoxical breathing
3. Resp rate > 25
4. Dyspnea.
5. PaCO2 > 45 w/pH < 7.35
6. P/F ratio < 200

Question 10

What are the goals for NPPV?

Answer 10

1. Improve acidosis
2. Improve resp. rate and HR

Question 11

When should you terminate NPPV and move on to Mech. ventilation?

Answer 11

1. worsening pH and CO2
2. RR > 30 bpm
3. Hemodynamic instability
4. Inability to clear secretions
5. Decreased LOC

Question 12

What would you normally set the pt on for NPPV?

Answer 12

1. CPAP
2. [S] Spontaneous mode
3. [S/T] spontaneous/timed mode
4. [T] Timed mode.

Question 13

BIPAP is a general name used for NPPV, what do we know it as?

Answer 13

Pressure support

Question 14

Does CPAP augment ventilation?

Answer 14

No. the breaths are spontaneous unsupported breaths (pt in full control)

Question 15

What are the following criteria for NIPPV?
1. Trigger
2. Limit
3. Cycle

Answer 15

1. Pt. triggered
2. Pressure limited
3. flow cycled

Question 16

What are the physiological effects of EPAP?

Answer 16

1. Increases FRC
2. Recruits alveoli (improves V/Q)
3. Reverses atelectasis
4. Improves compliance
5. causes mech. bronchodilation, decreasing airway resistance.

• Decreases WOB

Question 17

Do both IPAP and EPAP reduce WOB?

Answer 17

Yep