Podcast
Questions and Answers
What is the correct relationship between IPAP and EPAP in a BiPAP setup?
What is the correct relationship between IPAP and EPAP in a BiPAP setup?
What does a greater Delta value indicate in terms of ventilation?
What does a greater Delta value indicate in terms of ventilation?
What is the typical starting pressure setting for CPAP as stated?
What is the typical starting pressure setting for CPAP as stated?
What must be done to supply oxygen in simpler PAP units without direct oxygen supply lines?
What must be done to supply oxygen in simpler PAP units without direct oxygen supply lines?
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How does auto-titration function in newer BiPAP and CPAP models?
How does auto-titration function in newer BiPAP and CPAP models?
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What is the purpose of C-Flex and Bi-Flex settings in pressure therapy devices?
What is the purpose of C-Flex and Bi-Flex settings in pressure therapy devices?
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What is indicated if a patient’s FiO₂ is increased to 100% without improvements in oxygenation?
What is indicated if a patient’s FiO₂ is increased to 100% without improvements in oxygenation?
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What is the potential result of increasing FiO₂ when high pressures are a concern?
What is the potential result of increasing FiO₂ when high pressures are a concern?
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What does it mean when the IPAP and EPAP settings are equal in a PAP device?
What does it mean when the IPAP and EPAP settings are equal in a PAP device?
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What is the role of the 'Delta' value in the context of pressure support ventilation?
What is the role of the 'Delta' value in the context of pressure support ventilation?
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Which setting must be adjusted first if a patient exhibits low SpO₂/PaO₂ levels during CPAP therapy?
Which setting must be adjusted first if a patient exhibits low SpO₂/PaO₂ levels during CPAP therapy?
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What is a characteristic of the Flex settings in pressure therapy devices?
What is a characteristic of the Flex settings in pressure therapy devices?
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When does a shunt become evident in a ventilated patient?
When does a shunt become evident in a ventilated patient?
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In the context of oxygen therapy with PAP devices, how is oxygen typically 'bled-in' in home units?
In the context of oxygen therapy with PAP devices, how is oxygen typically 'bled-in' in home units?
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What does the auto-titration feature do in CPAP and BiPAP machines?
What does the auto-titration feature do in CPAP and BiPAP machines?
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What should the initial CPAP pressure settings typically range between?
What should the initial CPAP pressure settings typically range between?
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Which of the following statements about the relationship between IPAP and EPAP is true?
Which of the following statements about the relationship between IPAP and EPAP is true?
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What adjustment should be made first if a patient's SpO₂ levels are low?
What adjustment should be made first if a patient's SpO₂ levels are low?
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What is a characteristic of the Delta in relation to pressure support?
What is a characteristic of the Delta in relation to pressure support?
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What happens when FiO₂ is increased to 100% without improvements in oxygenation?
What happens when FiO₂ is increased to 100% without improvements in oxygenation?
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Which statement is true regarding the flex settings in pressure therapy devices?
Which statement is true regarding the flex settings in pressure therapy devices?
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What is the correct approach when a patient experiences high pressures during therapy?
What is the correct approach when a patient experiences high pressures during therapy?
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How is oxygen typically delivered in simpler PAP units without oxygen supply lines?
How is oxygen typically delivered in simpler PAP units without oxygen supply lines?
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Which setting adjustments are typically made to improve patient oxygenation during CPAP therapy?
Which setting adjustments are typically made to improve patient oxygenation during CPAP therapy?
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Study Notes
Positive Airway Pressure (PAP)
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Two levels of pressure: Inspiratory Positive Airway Pressure (IPAP) and Expiratory Positive Airway Pressure (EPAP)
- IPAP: Pressure applied during inspiration, typically between 4 to 24 cmH₂O.
- EPAP: Pressure applied during expiration, always equal to or less than IPAP.
- CPAP: Continuous Positive Airway Pressure, IPAP is equal to EPAP.
- BiPAP: Biphasic Positive Airway Pressure, IPAP is greater than EPAP.
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Delta/Pressure Support: The difference between IPAP and EPAP. Calculated as IPAP - EPAP.
- Higher Delta = Greater ventilation.
- Typical starting pressures: IPAP 12 cmH₂O, EPAP 6 cmH₂O.
Oxygen Therapy with PAP
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Oxygen delivery methods:
- Integrated oxygen delivery: Some PAP units deliver oxygen directly through the unit allowing for the selection of FiO2.
- Bled-in oxygen: Oxygen adapter placed in patient's circuit, supplied by a separate flowmeter.
- Estimated FiO2: May be estimated by adding 4% for each liter of oxygen bled in.
- Consider increased bleed-in: May need to add 1-2 liters of oxygen bleed-in when compared to nasal cannula oxygen therapy to account for oxygen being 'washed out' from the higher PAP flows.
Auto-Titration & Flex Settings
- Auto-Titration: Automatically adjusts PAP pressures based on patient breathing patterns.
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Flex settings: Slightly reduce pressure at the beginning of exhalation to ease expiration.
- C-Flex: Available on CPAP units.
- Bi-Flex: Available on BiPAP units.
- Settings: Typically 1 to 3, with 3 providing the most relief.
CPAP Titration/Management Considerations
- Starting pressures: Typically 8 to 12 cmH₂O.
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General rules of thumb:
- Low SpO2/PaO2: Increase FiO2 up to 50% (some resources recommend up to 60%).
- FiO2 at 50-60%: Increase CPAP pressure to improve oxygenation.
- High pressures: Increase FiO2, even if above 60%.
- FiO2 at 100% without improvement: Shunt is likely, increase pressure.
- Increased pressures fail or risk is too high: Intubation is indicated.
Positive Airway Pressure (PAP)
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Two levels:
- Inspiratory Positive Airway Pressure (IPAP): Typically ranges from 4 to 24 cmH₂O
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Expiratory Positive Airway Pressure (EPAP): Typically ranges from 4 to 24 cmH₂O, but always the same as or less than IPAP
- If IPAP and EPAP are equal, it becomes Continuous Positive Airway Pressure (CPAP)
- A BiPAP can be adjusted to function as a CPAP by setting IPAP equal to EPAP
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Delta (Pressure Support): The difference between IPAP and EPAP (Delta = IPAP - EPAP)
- Greater the Delta, greater the amount of ventilation
- Typical starting pressures: 12/6 cmH₂O (IPAP/EPAP)
Oxygen Therapy with PAP
- Hospital Units: May directly supply oxygen through the unit, allowing you to adjust the FiO₂
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Home Units: Do not have direct oxygen supply lines
- Oxygen must be "bled-in" using an adapter in the patient's circuit
- Oxygen is supplied from a flowmeter
- 1 to 15 liters per minute (lpm) can be bled-in
- Exact FiO₂ is difficult to determine, but can be estimated by adding approximately 4% for each liter bled-in
- Consider adding a liter or two more than the usual oxygen therapy for Nasal Cannula (N/C) due to "washout" of oxygen at higher PAP flows.
- Auto-Titration: Newer models automatically adjust pressures based on the patient's breathing pattern
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Flex Settings: Provide a slight pressure decrease at the beginning of exhalation to facilitate exhalation
- C-Flex: Used in CPAP units
- Bi-Flex: Used in BiPAP units
- Settings typically range from 1 to 3, with 3 providing the most relief (~3 cmH₂O)
CPAP Titration/Management Considerations
- Starting pressures: Typically 8 to 12 cmH₂O
-
General Rules of Thumb:
- Start at 8 to 12 cmH₂O
- If SpO₂/PaO₂ is low, increase FiO₂ up to 50% (some resources recommend up to 60%)
- Once FiO₂ reaches 50-60%, increase CPAP pressure to improve oxygenation
- If high pressures are a concern, increase FiO₂ even if above 60%
- If FiO₂ is increased to 100% without oxygenation improvement, a shunt is likely present. Increase pressures.
- If increased pressures fail or are too risky, intubation is indicated.
Pressures
- Two levels of pressure are used in PAP therapy: Inspiratory Positive Airway Pressure (IPAP) and Expiratory Positive Airway Pressure (EPAP).
- IPAP is the pressure delivered during inspiration, typically ranging from 4 to 24 cmH₂O.
- EPAP is the pressure delivered during expiration, also ranging from 4 to 24 cmH₂O, but must always be the same as or less than IPAP.
- When IPAP and EPAP are equal, the device operates as Continuous Positive Airway Pressure (CPAP).
- A BiPAP can function as CPAP by setting IPAP equal to EPAP.
Delta - aka Pressure Support
- The difference between IPAP and EPAP is known as Delta, or Pressure Support.
- Delta = IPAP - EPAP.
- A higher Delta provides greater ventilation.
Oxygen Therapy with PAP
- Oxygen therapy is often used in conjunction with PAP.
- Some units, especially in hospitals, may supply oxygen directly through the device, allowing you to select the desired FiO₂.
- Simpler units, like home units, require oxygen to be "bled-in" through an adapter in the patient's circuit, connected to a separate flowmeter.
- Oxygen bleed-in for simple units can range from 1 to 15 LPM.
- The exact FiO₂ in this case may be difficult to determine, but a rough estimation can be made by using 4%/liter of bleed-in, with an additional 1-2 liters added to account for "washout" from the higher PAP flows.
Auto-Titration
- Newe*r CPAP and BiPAP models often feature auto-titration, which automatically adjusts pressure levels based on the patient's breathing patterns.
Flex Settings
- C-Flex (for CPAP) and Bi-Flex (for BiPAP) provide a temporary decrease in pressure during exhalation to ease the patient's breathing.
- The pressure returns to its set value before the next inhalation.
- Settings typically range from 1 to 3, with higher settings offering more relief (approximately 3 cmH₂O).
Titration/Management Considerations: CPAP
- Initial CPAP pressures can vary, but are typically set between 8 to 12 cmH₂O.
- If the SpO₂/PaO₂ is low, increase the FiO₂ up to 50% (some resources suggest up to 60%).
- Once the FiO₂ reaches 50-60%, increase the CPAP pressure to enhance oxygenation.
- If high pressures are a concern, prioritize increasing FiO₂ even if it exceeds 60%.
- If FiO₂ is increased to 100% without improvement in oxygenation, a shunt is likely present. Increase the pressure in this case.
- ** If increased pressure fails to improve oxygenation or poses too high a risk, intubation may be necessary.**
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Description
Test your knowledge on Positive Airway Pressure (PAP) therapy, including Inspiratory and Expiratory Positive Airway Pressure levels. This quiz covers the differences between CPAP and BiPAP, as well as oxygen delivery methods associated with PAP. Perfect for healthcare students and professionals!
