Basics of Non Invasive Ventilation “CPAP or BiPAP’ with LTV 1200 Ventilator for CCT
What is Noninvasive positive pressure ventilation (NPPV/NIV)?
If a ventilator/machine is interfacing with a patient through a tight-fitting face mask rather than ET tube or a Tracheostomy tube then it’s NPPV or NIV period!
NPPV or NIV: encompasses the 3 modes available which are: CPAP*, Bi-level aka Bi-Pap, and PSV.
CPAP* is technically not a true mode, because it does not provide ventilatory assistance.
Who is the best candidate for Non Invasive Ventilation?
Best suited: are alert, cooperative patients (CHF with APE/COPD populace etc.), with open and patent airway on their own accord whose clinical course is expected to improve in 1-2 hours post NIV application.
Not suited are AMS patients with questionable airway reflexes or unable to clear secretions, high risk of aspiration, uncooperative patients with hemodynamic instability. Those patients need to be intubated! Subsequently placed on invasive mechanical ventilation.
Just like on Invasive Ventilation we have different modes for different patients, Non-Invasive Ventilation also has different modes
Different patient populations would require different modes depending on their disease process. (CHF vs. COPD)
CPAP = PEEP
CPAP = Continuous Positive Airway Pressure; PEEP = Positive End Expiratory Pressure
One set pre pressure for the entirety of the patient respiratory cycle. Does not matter if the patient is breathing in or out during the respiratory cycle.
CPAP* and PEEP provide Oxygenation*CPAP technically not a “true mode”, it allows for spontaneous breathing but does not provide support for ventilation.
“Bi-Pap” with two set pressures for PS/PEEP
Now if we have 2 set pressures one for when patient initiates inspiration with NIF by sucking air in and one for expiration we have a Bi-level mode.
PS=Pressure support ventilation PS elevates circuit pressure during inspiration and pressure augments patients tidal volume.
PEEP/CPAP during expirationPS provide VentilationPEEP provide Oxygenation
LTV-1200 vs. Standalone
To Sum it Up
PEEP=CPAP=EPAP = all mean the exact same thing, set is set based on OXYGENATION needs.
PSV/IPAP – this setting is for VENTILATION.
PSV/PEEP are the terms for the ventilator (hospital invasive capable vent. or LTV1200)
IPAP/EPAP are the terms for the standalone NPPV Machine such as BiPAP Vision.
Absolute vs. Additive
SOMETHING EXTREMELY IMPORTANT THAT GETS OVERLOOKED AND CAN BE DELETERIOUS TO YOUR PATIENTS!
Ventilators are ADDITIVE (PS is in addition to PEEP)
Standalone are ABSOLUTE (IPAP and EPAP are separate entities NOT in addition to each other)
Why It Matters!
PIP/Ppeak of >30 cmH20 with NIV can cause gastric insufflation by entraining air into the gastric tract.
NIV Mask is not like ET tube that sits in the trachea and isolates the lungs.
Gastric insufflation can lead to patient vomiting and risk of aspiration with tight sealed mask on the face
Gastric decompression via NG/OG tube need to be considered if a face mask is used.
THUS YOU ALWAYS NEED TO OBTAIN 3 PARAMETERS
▪PIP in cmH20
▪PS/PEEP ON VENTILATORS
▪IPAP/EPAP ON STANDALONE MACHINES
PIP is 15 cmH20
PEEP 5 cmH20
Delta P change in pressure is 10. I got that my doing: 15 – 5 = 10 cmH20
That means PS (Pressure Support) setting is 10cmH20
We set the NIV based on patient needs!
▪Do they have oxygenation problem?
▪Do they have a ventilation problem?
▪Type I Respiratory failure of oxygen exchange (Oxygenation issue)
CHF with APE (classic example)
CPAP =PEEP=EPAP = Oxygenation Issues for patients with Type I Hypoxemic failure of oxygen exchange (Oxygenation issue)
Start at 5cmH2O for this subset of patients and titrate based on response.
▪Type II Respiratory failure of carbon dioxide exchange (Ventilation issue)
Acute exacerbation of COPD (classic example)
PSV/IPAP during inspiration
PEEP/CPAP/EPAP during expiration
For Type II Hypercapnic failure of carbon dioxide exchange (Ventilation issue)
(Ventilation issue) COPD
Start with PSV/IPAP of 8-10cmH20 and 0 or ZEEP =Zero End Expiratory Pressure for PEEP/CPAP/EPAP these patients do not have oxygenation issues.
Youtube video presentation and equipment demonstrations
(Part 1) Basics of Non Invasive Ventilation “CPAP or BiPAP’ with LTV 1200 Ventilator for CCT
(Part 2) Basics of Non Invasive Ventilation “CPAP or BiPAP’ with LTV 1200 Ventilator for CCT
(Part 3) Basics of Non Invasive Ventilation “CPAP or BiPAP’ with LTV 1200 Ventilator for CCT