Noninvasive Ventilation and CPAP/BiPAP Overview

A scoring system used to assess the level of sedation in mechanically ventilated patients, aiming for a score between -2 and 0.

A condition where the body's tissues and organs do not receive enough oxygen.

A technique that uses positive pressure to deliver air into the lungs, which can affect hemodynamics by increasing intrathoracic pressure, reducing venous return, and decreasing cardiac output.

The primary reasons for placing a patient on a ventilator.

A decrease in blood pressure that can occur after initiating positive-pressure ventilation due to reduced venous return and cardiac output.

Noninvasive positive-pressure ventilation (NPPV) is the first-line therapy for managing COPD exacerbations and acute cardiogenic pulmonary edema (ACPE).

NPPV is generally avoided for definitive management of pneumonia or acute respiratory distress syndrome (ARDS).

BiPAP provides two levels of pressure, inspiratory and expiratory, while CPAP maintains a single constant pressure.

BiPAP settings should be evaluated frequently to assess patient tolerance and the need for titration.

PC ventilation delivers breaths at a predetermined pressure with variable volume, unlike VC ventilation which delivers a set volume with varying pressures.

A/C ventilation provides a specific number and volume of breaths per minute, while SIMV synchronizes mandatory breaths with the patient's spontaneous efforts.

Elevated ventilation pressures might indicate ventilator circuit obstruction, bronchospasm, mainstem intubation, tension pneumothorax, hemothorax, decreased chest wall compliance, or increased chest wall rigidity.

The maximum recommended plateau pressure during mechanical ventilation is below 30 cm H₂O.

A noninvasive method of delivering positive pressure to the lungs, typically using a mask or nasal prongs.

The first-line treatment for acute exacerbations of chronic obstructive pulmonary disease (COPD) and acute cardiogenic pulmonary edema (ACPE).

NPPV is generally avoided for definitive management of these conditions, as alternative methods are usually more effective.

Conditions where NPPV might still be used despite being generally avoided.

The main advantage of VC is that it ensures a consistent tidal volume, which can be crucial for patients with specific ventilation needs.

Assist-Control (A/C) ventilation provides a specific number and volume of breaths each minute regardless of patient effort.

SIMV synchronizes mandatory breaths with the patient's spontaneous efforts, while A/C delivers breaths regardless of patient effort.

Both A/C and SIMV can be used with either pressure-controlled or volume-controlled ventilation.

The initial pressure settings for BiPAP typically involve an inspiratory pressure of 10 cm H₂O and an expiratory pressure of 5 cm H₂O.

Low ventilation pressures combined with hypoxia might indicate a leak in the ventilator circuit, faulty connection, or even accidental extubation.

The Richmond Agitation Sedation Score (RASS) is a widely used scoring system to assess a patient's level of sedation.

The target RASS score for sedation is between -2 and 0, indicating a mild sedation level.

Prolonged neuromuscular blockade can cause complications like muscle weakness and a longer recovery period.

Spontaneous breathing creates negative pressure in the chest cavity through diaphragm and intercostal muscle contraction, drawing air into the lungs.

Positive pressure ventilation increases intrathoracic pressure, which can reduce venous return and decrease cardiac output.

Hypotension might occur after initiating positive pressure ventilation because it reduces venous return and cardiac output, especially in patients with low blood volume or dilated blood vessels.

The two main reasons for initiating ventilatory support are respiratory failure and to protect the airway.

Positive pressure ventilation increases intrathoracic pressure, while spontaneous breathing decreases it.

Positive pressure ventilation can reduce venous return, decrease cardiac output, potentially leading to hypotension.

Positive-pressure ventilation is a method used to aid in breathing by delivering breaths through a mechanical device.

The main advantage of VC is that it ensures a consistent tidal volume, which can be important for patients with specific ventilation needs.

The main advantage of VC is that it ensures a consistent tidal volume, which can be important for patients with specific ventilation needs.

Both A/C and SIMV can be used with either pressure-controlled or volume-controlled ventilation.

The initial pressure settings for BiPAP typically involve an inspiratory pressure of 10 cm H₂O and an expiratory pressure of 5 cm H₂O.

Low ventilation pressures combined with hypoxia might indicate a leak in the ventilator circuit, faulty connection, or even accidental extubation.

The Richmond Agitation Sedation Score (RASS) is a widely used scoring system to assess a patient's level of sedation.

The target RASS score for sedation is between -2 and 0, indicating a mild sedation level.

Prolonged neuromuscular blockade can cause complications like muscle weakness and a longer recovery period.

A type of mechanical ventilation that delivers a predetermined volume of air with variable pressure.

VC ensures a consistent tidal volume, which is the amount of air delivered per breath.

VC can lead to high airway pressures, potentially causing lung injury or barotrauma.

VC is well-suited for conditions like ARDS, where maintaining a consistent tidal volume is critical.

A type of mechanical ventilation that sets a specific airway pressure with variable tidal volume.

PC minimizes barotrauma, a type of lung injury caused by high pressure.

PC is beneficial for patients with high respiratory drive, as it allows for more synchronized breathing.

PC does not guarantee a specific tidal volume, unlike VC.

This mode delivers a specific number of breaths per minute and assists any additional breaths initiated by the patient.

This mode delivers a predetermined number of breaths but allows the patient to breathe spontaneously between them.

This mode provides no mandatory breaths, allowing the patient to control the rate and depth of breaths.

A/C assists every breath, while IMV only assists mandatory breaths, allowing spontaneous breathing in between.

A combination of volume and pressure strategies, often used to deliver a set tidal volume while minimizing airway pressure.

The control variable in mechanical ventilation refers to how the ventilator delivers gas – by setting the volume (VC) or the pressure (PC).

Spontaneous breathing creates a negative pressure in the chest cavity through muscle contractions, drawing air into the lungs.

Positive-pressure ventilation delivers air under pressure, unlike spontaneous breathing, which relies on negative pressure.

Positive pressure ventilation can reduce venous return and decrease cardiac output, potentially causing hypotension.

VC is ideal for patients requiring strict control of tidal volume, such as those with ARDS or decreased chest wall compliance.

PC is suitable for patients requiring strict airway pressure control, such as those with severe asthma or COPD.

High airway pressures and barotrauma due to the delivery of a set tidal volume.

Unpredictable tidal volume, potentially leading to inadequate ventilation.

ARDS, obesity, and severe burns are conditions best managed with VC.

Severe asthma, COPD, and salicylate toxicity are conditions best managed with PC.

VC, PC, AC, IMV, and CSV are all different ventilation modes with unique characteristics and applications.

VC delivers a set volume of air with variable pressures to ensure consistent minute ventilation, but it risks high airway pressures.

VC delivers a consistent tidal volume, crucial for patients with specific ventilation needs, like ARDS.

PC minimizes barotrauma by setting a specific airway pressure with variable tidal volume.

PC controls airway pressure, reducing barotrauma risk and improving synchrony in patients with high respiratory drive.

VC guarantees tidal volume, but risks high lung pressures, suitable for conditions like ARDS or obesity.

A/C delivers a preset number of breaths per minute and assists any additional breaths initiated by the patient.

IMV delivers a preset number of breaths, allowing spontaneous breathing between mandatory breaths.

CSV provides no mandatory breaths, allowing the patient to control the rate and size of breaths, with optional pressure or volume support.

It refers to the volume of air delivered per breath, a crucial factor in ensuring adequate ventilation.

It refers to the number of breaths taken per minute, influencing the total volume of air moved in and out of the lungs.

It describes the pattern of airflow during inspiration, impacting how quickly air enters the lungs.

It's the duration of the inspiratory phase, determining how long air flows into the lungs.

It represents the peak pressure reached during inspiration, reflecting the force needed to deliver air.

It indicates the pressure at the end of inspiration, reflecting how the lungs are expanding and resisting airflow.

PRVC combines volume and pressure control, delivering a set tidal volume while minimizing airway pressure.

Still risks high airway pressures if lung compliance changes, and does not offer significant advantages over traditional VC or PC in all cases.

It's the pressure maintained at the end of expiration, preventing airway collapse and promoting gas exchange.

It's the rate at which air flows into the lungs during inspiration, impacting the delivery of oxygen and removal of carbon dioxide.