BiPAP Vision: BiPAP Treatment Guide PDF

BIPAP BI-LEVEL POSITIVE AIRWAY PRESSURE JERICKSON A. BAYANI, RTRP  BIPAP An airway strategy that applies independent positive pressure to both inspiration and expiration. Noninvasive ventilation  BIPAP MACHINE A ventilator especially designed for noninvasive ventilation. Use in any loc...

BIPAP BI-LEVEL POSITIVE AIRWAY PRESSURE JERICKSON A. BAYANI, RTRP  BIPAP An airway strategy that applies independent positive pressure to both inspiration and expiration. Noninvasive ventilation  BIPAP MACHINE A ventilator especially designed for noninvasive ventilation. Use in any location where noninvasive ventilation is administered.  TWO TYPES OF PRESSURE IPAP (Inspiratory Positive Airway Pressure) - Provides positive pressure (PIP) and it improves hypoxemia and hypercapnia. EPAP ( Expiratory Positive Airway Pressure) - Provides (PEEP) and it improves oxygenation. Increasing FRC and alveolar recruitment  INDICATIONS Preventing intubation of end stage COPD patient Supporting patient with chronic ventilatory failure Patients with restrictive chest wall diseases Neuromuscular diseases Nocturnal hypoventilation Supportive ( Post Extubation) CONTRAINDICATIONS Hypotension Pneumothorax Acute sinusitis Increased secretions MODES Spontaneous – the IPAP and EPAP may be set 8 cm H20 and 3 cm H20 with normal back up rate. Spontaneous/Time – the back up rate set five (5) below the patient’s RR. Time mode – the back up rate should be higher than the patient’s RR.  INITIAL SETTINGS IPAP- 8 cm H2O EPAP- 3 cm H2O Back up rate- depends on patient’s spontaneous FIO2- 60% %IPAP- for I:E ratio 33%= 1:2, 50%= 1:1 Note: Initial settings should be base on ABG. ADJUSTMENT OF IPAP AND EPAP IPAP- increment of 2 cm H2O EPAP- increment of 2 cm H2O Back up rate- increment of 2 bpm FIO2- 5% to 10% Note: Increasing the tidal volume may be obtained by increasing the IPAP and decreasing the EPAP.  GOALS OF BIPAP To improve oxygenation To improve ventilation To improve lung compliance To improve muscle fatigue To decrease work of breathing  COMPLICATIONS Throat and Nasal Irritation – dryness Nasal Lesions - develop sores, numbness around the mask area Stomach Bloating – air swallowing Ear Complications – hearing difficulties Eye infections – conjunctivitis COMPLICATIONS TYPES OF BIPAP MASK Face Mask Total Face Mask Nasal Mask BIPAP MASK COMMON ERRORS IN BIPAP Leak Wrong settings Wrong size of Mask No oxygen Disconnection EXAMPLES OF BIPAP MACHINE NEW BIPAP MACHINE Display Screen provides complete information for patient monitoring. Measured Inspiratory (IPAP) and Expiratory Pressures (EPAP) Oxygen Module Exhaled Tidal Volume (Vt) Exhaled Minute Ventilation (MinVent) Inspriatory Time/Total Cycle Time (Ti/Ttot) Patient Leak (Pt. Leak) % Patient Triggered Breaths (Pt. Trig) Complete range of alarms MANAGEMENT A 7 yr old boy was diagnosed with obstructive sleep apnea and was being ventilated on a non invasive ventilator. BIPAP SETTINGS IPAP 10 EPAP 4 RR 20 FiO2.50 ABG pH 7.30 PaO2 80 PCO2 50 HCO3 21 SaO2 95% Based on this data which of the following ventilator settings should the respiratory therapist recommend