High Acuity Care Needs: HFNP, CPAP, BiPAP & Invasive Ventilation PDF

11857 Health Across Lifespan - High acuity care needs Mini Lecture – HFNP, CPAP, BiPAP(NIV) and Invasive Mechanical Ventilation Kate Steirn 11857 Health Across Lifespan - High Acuity Lecture Objectives High flow assist devices High flow nasal prongs (HFNP) Ventilator terminology No...

11857 Health Across Lifespan - High acuity care needs Mini Lecture – HFNP, CPAP, BiPAP(NIV) and Invasive Mechanical Ventilation Kate Steirn 11857 Health Across Lifespan - High Acuity Lecture Objectives High flow assist devices High flow nasal prongs (HFNP) Ventilator terminology Non-invasive Ventilation Continuous positive airway pressure (CPAP) Bi-level positive airway pressure (BiPAP) Nursing management Invasive ventilation Basics Nursing management High flow nasal cannulae (HFNP) Have larger prongs to facilitate oxygen flow of up to 60L/min Generate low levels of PEEP (explain further) And can therefore reduce tachypnoea and WOB. Prevents CO2 rebreathing and therefore decreases PaCO2 Well tolerated Must be used with humidification Comparison Flow and FiO2 Flow (L/min) FiO2 Comfort Mouth or nose breathing Nasal cannula 1- 6 24-40% Yes Nose Face mask 6-10 35-60% Mod Mouth Venturi mask 2-15 24-50% Mod Mouth Non-rebreather 10-15 50-90% No Mouth High flow nasal 15-60 30-100% Mod Nose cannula Ventilator Terminology FiO2 – fraction of inspired oxygen or O2 concentration 30-100% Respiratory Rate (RR) – no of breaths per minute Tidal Volume (Vt) - is the volume of gas moved into or out of the lung in a single normal inspiration and expiration. Minute Volume (Ve) - is the volume of gas moved in and out of the lungs in one minute. i.e. Vt x RR. Positive End Expiratory Pressure (PEEP) or End expiratory positive airway pressure (EPAP) – the amount of pressure still in the lungs/alveoli at the end of expiration. Pressure Support (PS) - push of air to help Patient with spontaneous breath Peak inspiratory pressure (PIP) – maximum amount of pressure during inspiration Non-invasive ventilation (NIV) CPAP and BiPAP are 2 different versions of NIV or non-invasive positive pressure ventilation (NPPV) Both CPAP and BiPAP requires patient to trigger breathing (patent airway and adequate level of consciousness) Both CPAP and BiPAP preserves the patient’s ability to speak, swallow, cough and clear secretions and decreases risks associated with endotracheal intubation May have increased FiO2 or may just have pressure controls CPAP BiPAP Continuous Positive Airway Pressure (CPAP) Indications ARDS, cardiac pulmonary oedema (HF), bilateral, diffuse pneumonia, Type 1 respiratory failure (PaO2 60mmHg), Obesity hypoventilation Benefits: Same benefits as CPAP as we are still applying EPAP in this mode as well but has added benefit of pressure support on inspiration which significantly decreasing the work of breathing required. avoidance of inspiratory muscle fatigue through the addition of inspiratory positive pressure thus reducing dyspnoea increases tidal volume which increases the elimination of CO2 and reverses acidaemia BiPAP / PS ventilation PEEP (EPAP) = 5cm H2O PS (IPAP) = 7cm H2 Peak inspiratory pressure (PIP) PEEP + IPAP 5 + 7 = 12cmH2O Nursing monitoring requirements Patient education – outlining benefits/rationale for intervention Ensure mask fits face and provides good seal and monitor for presence of air leaks Full MEWS and NIV observations are completed, on both the NIV and MEWS charts, half hourly for the first four hours, then hourly for the first 24 hours recording the following: Patient monitored for respiratory and haemodynamic stability (Oxygen saturation + cardiovascular observations) Flow rate of supplemental oxygen if required NIV settings Time on and time off machine Nursing Monitoring requirements cont.. Patient comfort (Claustrophobia leading to agitation) and accessory muscle use Coordination of respiratory effort with the ventilator Fluid balance chart Skin integrity – check at all pressure points i.e. bridge of nose, tips of ears Ensure all equipment used on the patient is cleaned in the correct manner as per the manufactures instructions. Nasal congestion or nasal dryness Invasive ventilation - intubated Patients Synchronised intermittent mandatory ventilation. Pressure regulated volume control (SIMV-PRVC) Set: RR, FiO2, PEEP, Vt, PS + other settings Synchronised with patients own intrinsic breathing Patient triggered breath Pressure supported – same as biPAP Mandatory ventilation only when required if patient doesn’t initiate breath Volume control – controls volume of mandatory breaths only Pressure regulated – pressure is regulated to prevent barotrauma. (Usually set to 35cm H2O) as an alarm that pressure is high and will cut off a breath if pressure too high (usually 40cmH2O). Invasive ventilation - intubated Patients Pressure support ventilation (PSV) – Weaning mode Set: FiO2, PEEP, PS No RR is set - Patient must trigger every breath. Ventilator delivers a pressure boost to patient own breath Exactly the same as BiPAP only not via a mask is via a ETT or trachy. Nursing monitoring requirements Assessing and maintaining airway. (ETT or Tracheostomy) Suctioning equipment Always have emergency adjunctive airways and BVM at bedside Check circuit - Humidified circuits Ventilator settings and alarms Coordination of respiratory effort with the ventilator Monitor waveforms and capnography Patient monitored for respiratory and haemodynamic stability (Oxygen saturation + cardiovascular observations) Skin integrity – check at all pressure points i.e. ETT in mouth a lips and tapes around face/neck etc. References ACT Health (2021) Non-invasive ventilation management for adult patients outside the ICU HDU Retrieved from: https://www.canberrahealthservices.act.gov.au/about-us/policies-and- guidelines?result_1981007_result_page=16 Aitken, L., Marshall, A., & Buckley, T. (2024). Critical Care Nursing (5 th ed). Elsevier Craft, J.C., Gordon,C.J., Huether,S.E., McCance,K.L., & Brashers, V.L. (2020) Understanding pathophysiology (4th ed.). Elsevier. Dorman Wagner. K., & Hardin-Pierce, M. G. (2015). High-Acuity Nursing, Global Edition (6th ed). Pearson Margutti, E.M., Brambilla, A.M., Maraffi, T., & Cosentini, R. (2017) Non-invasive ventilation in acute respiratory failure: the key “w” questions. Internal and Emergency Medicine Vol 12, pp1307-1311. Yartsev, A (2023) Effects of positive pressure ventilation on pulmonary physiology. Retrieved from: https://derangedphysiology.com/main/cicm-primary-exam/required-reading/respiratory- system/Chapter%20522/effects-positive-pressure-ventilation-pulmonary-physiology  The University of Canberra acknowledges the Ngunnawal people, traditional custodians of the lands where Bruce Campus is situated. We wish to acknowledge and respect their continuing culture and the contribution they make to the life of Canberra and the region. We also acknowledge all other First Nations Peoples on whose lands we gather. The University of Canberra acknowledges the Ngunnawal people, traditional custodians of the lands where Bruce Campus is situated. We wish to acknowledge and respect their continuing culture and the contribution they make to the life of Canberra and the region. We also acknowledge all other First Nations Peoples on whose lands we gather.