1. 1 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

2. 2 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. SECTION 4 Ventilation

3. 3 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Chapter 24 Noninvasive Positive-Pressure Ventilation

4. 4 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Definition of Noninvasive Positive-Pressure Ventilation Noninvasive positive-pressure ventilation (NPPV) is the application of positive pressure via the upper respiratory tract for the purpose of augmenting alveolar ventilation (ARCF, 1997).

5. 5 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Indications for Noninvasive Positive-Pressure Ventilation Acute exacerbation of chronic obstructive pulmonary disease Acute hypoxemic respiratory failure Community-acquired pneumonia Postoperative respiratory failure (continues)

6. 6 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Indications for Noninvasive Positive- Pressure Ventilation (continued) Acute cardiogenic pulmonary edema Weaning from ventilatory support Severe acute asthma Do not resuscitate/do not intubate orders

7. 7 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Assessment of the Patient for Non-invasive Positive-Pressure Ventilation Assessment should include: –Determination of ventilatory parameters –Arterial blood gases –Oxygen saturation –Work of breathing and detection of changes in the patient’s vital signs

8. 8 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Patient-Ventilator Interface to Noninvasive Positive-Pressure Ventilation Patient comfort is important in tolerance of NPPV –Type of mask Nasal Full-face –Type of harness –Fit of mask

9. 9 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. How Resistance and Compliance Affect Noninvasive Positive-Pressure Ventilation Changes in resistance affect inspiratory time. Changes in compliance effect volume delivery at a set pressure. Monitor delivered tidal volumes, SpO 2, and blood gases.

10. 10 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Modes of Noninvasive Positive-Pressure Ventilation Pressure adjustment Spontaneous Spontaneous/timed Timed

11. 11 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Supplemental Oxygen Delivery If the adjustment of oxygen concentration is not provided, oxygen must be bled into the circuit: –Through an adapter at the outlet –Into a port on the nasal mask Acute Care Ventilators Ventilator Circuit

12. 12 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Patient Monitoring Monitors used should include: –Oxygen saturation –Cardiac –Blood pressure –Oxygen analysis monitors

13. 13 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Patient Assessment for NPPV Assessment may include: –Physical assessment –Oximetry –Arterial blood gas analysis –Determination of ventilatory parameters

14. 14 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Assembly and Testing of the Ventilator Testing circuit integrity –Block the mask interface and place the ventilator into the timed mode with a set rate. –Observe for the pressure to rise to the set IPAP level. –If the pressure fails to rise, you have a leak. –Check all connections.

15. 15 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Mask Selection Nasal masks Full-face masks Head gear or straps Spacers Remember that if the mask is correctly fitted, little pressure will be required to seal it.

16. 16 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Ventilator Settings The physician may order specific: –Pressures IPAP EPAP –Rate –F I O 2

17. 17 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Patient Monitoring ECG Continuous oximeter Noninvasive blood pressure Continuous oxygen

18. 18 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Patient Charting Patient charting should include: –Breath sounds –Heart rate –SpO 2 –Work of breathing –IPAP –EPAP –Mode –Ventilatory rate –Tidal volume –Estimated leak –Ventilator rate (backup) –F I O 2