List the first 5 steps
- Intruduce Self and explain the precedure
- Connect NPPV to electric power and 50 psi gas source
- Connect inspiratory filter and breathing circuit
- Input mask number and type of valve use on the circuit
- Input order IPAP/EPAP, FiO2 setting
On the NPPV setting steps 6-9 consist of?
- Set:
A) Back Rate (10-12)
B) Ti ( 1 ) Inspiratory Time
C) Rise time ( 3 )
7. Size Patient for full face mask
8. Place mask to patient’s face and connect to ventilator
9. Check record mask leak and adjust to minimize
NPPV setting # 10
- Set alarms:
- Hi Rate (10 - 15 > more patient rate)
- Low Rate ( 10 less patient rate, no less than 8)
- Hi VT
- Lo VT
- HIP ( 10 - 15 > than IPAP)
- LIP ( > EPAP, < IPAP)
- Lo VE ( 1 - 2 < patient’s minute volume)
- LIP T ( 20 sec)
On NPPV setting # 11, 12 and 13?
11. Notes:
A) VT
B) Minute Vent.
12. Place SVN in line at 6 L/min
13. Change to CPAP mode, set LIP alarm 2 - 5 cm H2O bellow CPAP level.
What would you do in this escenary
- PH 7.51, PaCO2 31, PaO2 80 HCO3 24
- IPAP 20, EPAP 5, FiO2 .50
- Here we have an acute alveolar heperventilation with normoxemia.
- Pressure Support is 15
- we just need to fix ventilation because PaO2 is normal
- Here we reduce IPAP by 3, reducing Pressure Support to 12 and we keep the rest as it is.
- With this adjusment PH and PaCO2 should be back to normal
How you fix this?
PH 7.45, PaCO2 35, paO2 55, HCO3 24
IPAP 12, EPAP 5, FiO2 .50
- Here we have normal ventilation with hypoxemia.
- Pressure support is 7
- Increase IPAP and EPAP by 3 ( IPAP 15, EPAP 8) with this adjustment we keep the same pressure support of 7, but we improved Oxygenation which should bring PaO2 back to normal (>60).
IPAP 20, EPAP 10, FiO2 .60
PH 7.41, PaCO 42, PaO2 123, HCO3 24
what would you do here?
- This is a normal ventilation wih hyperoxemia.
- Pressure Support is 10.
- Ok, since ventilation is ok I will keep the sme pressure support fixing just PaO2.
- I reduce FiO2 by 10% leaving it on 50%.
- with this movement FiO2 should be back to normal range.
IPAP 12, EPAP 5, FiO2 .50
PH 7.32, PaCO2 51, PaO2 55, FiO2 24
How you fix this on your ventilator?
- Acute Alveolar Hypoventilation with Hypoxemia.
- Pressure support is 7.
- Here I need to correct Ventilation and Oxygenation.
- We move up IPAP and EPAP by 3 (IPAP 15, EPAP 8).
- With this movement we increased base line from 5 to 8 fixing our oxygenation problem, but we still keeping the same pressure support of 7, which mean that we still having ventilation problem.
- So now, we just increase IPAP by 3 (from 15 to 18), increasig pressure support up to 10, fixing our ventilation problem.
IPAP 12, EPAP 5, FiO2 .40
PH 7.32, PaCO2 49, PaO2 65, HCO3 24
Please fix this!!
- This is hypoventilation with normoxemia.
- Pressure support is 7
- Here, since O2 it’s fine, we just need to fix ventilation.
- So, we increase IPAP by 3 (from 12 to 15), increasing pressure support up to 10.
- Now our ventilation should be back to normal.
IPAP 10, EPAP 5, FiO2 .50
PH 7.39, PaCO2 45, PaO2 65, HCO3 24
What Would you do?
- Ventilation it’s fine.
- Oxygenation is good
- Pressure Support is 5
- Here we have a normal patient.
- No changes need it.
IPAP 20, EPAP 10, FiO2 .40
PH 7.35, PaCO2 45, PaO2 119, HCO3 24
Fix it, if there is a problem.
- Patient is ventilating ok, but is hyperoxic
- Presure Support is 10
- Here I just need to fix Oxygenation, reducing IPAP and EPAP by 3 until O2 comes back to normal, always keeping he same pressure support to maintain ventilation in the normal range.
