CPAP

Terminology NIV: Non-invasive ventilation CPAP: Continuous positive airway pressure BPAP: Bilevel positive airway pressure BiPAP is brand name of BPAP

How it Works Increases pressure in the lungs and holds open collapsed alveoli and narrowed bronchioles Our patients with emphysema do this  pursued lip breathing. Can help push the fluid from CHF out of the alveoli back into the capillaries Can help get air past mucous plugs Can help push more oxygen across the alveolar membrane Reduces work of breathing

Side effects Also increases intrathoracic pressure which will lower blood pressure A plus if patient is hypertensive A negative if patient is not hypertensive Can be very claustrophobic Can force some air into the stomach Watch for vomiting

Conditions help by CPAP Must be a spontaneously breathing patient Moderate to severe respiratory distress from: Congestive heart failure/pulmonary edema COPD Asthma Pneumonia Submersion injury Undifferentiated respiratory distress Also used for sleep apnea

VT Requirements District 11, use it when we think clinically necessary VT protocol indications implies all these must be present: Oxygen saturation <94% Respiratory rate > 25 Retractions or accessory muscle use District 11, use it when we think clinically necessary

contraindications Cardiac or respiratory arrest/apnea Unable to follow commands Unable to maintain their own airways Agitated or combative behavior and unable to tolerate mask Vomiting and/or active GI bleed Respiratory distress secondary to trauma, why? Suspicion of pneumothorax, why? Facial trauma or impossible to seal face Hypotension with SBP< 100 mmHg

procedure Ensure adequate O2 supply for CPAP device Explain procedure to patient – be prepared to coach for claustrophobia Place patient in upright position – apply pulse oximetry, capnography with nasal capture device Choose appropriate sized mask, assemble device, attach to O2 supply and insure O2 is flowing Place mask over face and secure with straps until minimum air leak Adjust pressure to 5-10 cm H2O – titrate for effect

7. Recheck mask for leaks and readjust straps as needed 8 7. Recheck mask for leaks and readjust straps as needed 8. Reassure anxious patient 9. Monitor vital signs, pulse oximetry, quantitative wave form capnography, and patient symptoms/ status 10. If patient improves, maintain CPAP for duration of transport and notify receiving hospital so they can have BPAP/CPAP ready on arrival 11. If patient begins to deteriorate, remove CPAP and assist respirations with BVM

Monitoring/documentation Document CPAP procedure including time and provider. Document serial pulse oximetry, serial capnography, respiratory rate and effort Improving? If not why? Reconsider use? Close monitoring for nausea/vomiting Close vital sign monitoring especially BP. How often? Why?

Complications Hypotension Anxiety/ Claustrophobia Impaired communication Vomiting High risk for aspiration

Medics - Consider anxiolytic, with medical control, to tolerate the CPAP

Sources VT EMS Protocols http://lifeinthefastlane.com/ccc/non-invasive-ventilation- niv-and-asthma/ http://lifeinthefastlane.com/ccc/non-invasive-ventilation- niv/