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Ideal Breathing Pattern
- Slow, deep inspiration
- Inspiratory Pause/hold
- Exhalation slow, passive and relaxed
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What is a sustained maximal inspiration (SMI, Incentive Spirometry)
- Prevent atelectasis
- Prevent areas of lung from collasping
- Surgical pts taught prior to surgery
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Troubleshooting IS
Patients must be reminded to inhale and not exhale into device.
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Indication IPPB therapy
- Prevent/correct atelectasis unable to take deep breath.
- Prevent or decrease pulmonary edema
- Decrease WOB
- Mechanical bronchodilation
- Distribute aerosols evenly for better deposition of meds
- Removal airway secretions/mobilize secretions
- Manipulation insp exp pattern
- Improve alveolar collateral vent
- Improve & promote cough mechanism
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Contraindications IPPB Therapy
- Pul hemorrhage
- Untreated pneumothorax
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Hazards IPPB
- Dizziness
- Tingling fingers, instruct pt breathe slower
- Pneumothorax
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Flow Rate Control IPPB
Turning knob higher # causes greater flow into mainstream breathing circuit and nebulizer (decrease I-time)
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IPPB Pressure
- Volume changed adjusting pressure limit
- Leaks in circuit prevent normal cycling to exhalation.
- Obstruction/coughing ends inspiration
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IPPB Sensitivity
- Negative 1.0-2.0 cm H2O
- Decrease sensitivity-self cycling occurs if respirator is set too sensitive
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IPPB has Excessive Pressure
- Obstruction
- Excessive Flow
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IPPB fails to cycle into inspiration
- Adjust sensitivity
- Tight seal around mouthpiece
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IPPB fails to cycle off
- Leak
- Mouthpiece/mask seal
- Cuff leaking
- Fenestrated trach tube open
- loose equipment connection
- Pressure does not rise normally
- insufficient flow
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Mask CPAP
Short term, temp use for improving oxygenation in patients with CO2 poisoning, PNA, post-op atelectasis
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Nasal CPAP
- Neonates who are nose breathers
- Can lose CPAP if baby is crying give pacifier
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CPAP Increased Pressure
- Obstruction
- Excessive flow continuous venting of pop off valve will occur
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NPPV Indications
- Avoid intubations w/ COPD,CHF,pul edema
- Long term vent @ home
- Provide support to pts w:
- Neuromuscular disease
- Restrictive chest wall disease
- OSA/Central Sleep Apnea
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What is EPAP?
Same as CPAP, improves oxygenation or prevent airway closure in OSA.
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What is IPAP?
- Set higher pressure than EPAP, postive pressure during insp. phase
- Stimulate pressure support vent w/CPAP
- Maintain patent airway in OSA
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Settings on NPPV
- EPAP 5-10 OSA uncomplicated
- EPAP 6-8 tx hypoxemia
- IPAP greater than EPAP
- I:E Ration 1:2
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