1. Indication for CPAP
    1. increase oxygenation

    2. support oxygenation at lower fiO2
  2. Troubleshoot CPAP:

    What does loss of pressure indicate?
    1. Leak

    2. Insufficient flow
  3. Troubleshoot CPAP:

    What does increased pressure indicate?
    1. Obstruction

    2. With excess flow, a continuous venting of the pop-off valve will occur
  4. What are some indications of NPPV?
    1. to avoid intubation in pts with: COPD, CHF, Pulmonary Edema

    2. Facilitate long term ventilation at home

    • 3. Provide Periodic support for pts with:
    • a: Neuromuscular disease
    • b: Restrictive chest wall disease
    • c: Central/Obstructive Sleep Apnea
  5. NPPV:

    Contraindications and Hazards?
    1. Poor fitting mask

    2. Irritation or ulceration from mask

    3. Leaks around mask or in tubing

    4. Gastric distention from high pressures

    5. Contraindicated for pts with dysphagia
  6. NPPV Modes:

    EPAP: Expiratory positive airway pressure
    This is the same as CPAP and can be used to improve oxygenation or to prevent airway closure in OSA
  7. NPPV Modes:

    IPAP: Inspiratory Positive Airway Pressure
    This is set higher than EPAP, + pressure applied during inspiration.

    Used to maintain patent airway in OSA

    Can also be used with pt who req. inspiratory assist to maintain adequate ventilation following extubation to avoid intubation and cmv
  8. NPPV modes:

    Spontaneous/Timed (ST)
    1. Allows pt to breathe at spontaneous rate with combined timed breaths as in SIMV

    2. Bipap

    3. The timed breaths are controlled by selecting a rate and an i time percent
  9. NPPV Modes:

    1. provieds only time controlled breaths at selected inspiratory and expiratory pressures

    2. the pt can't trigger additional mandatory breaths. I timepercent must be selected and monitored to determine the delivered VT
  10. NPPV General considerations:

    what EPAP pressures will a pt with uncomplicated sleep apnea generally find relief?
    5-10 cwp
  11. NPPV General considerations:

    A pt placed on EPAP for tx of hypoxemia should be started at what pressure?
    6-8 cwp and increase as necessary
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