Continuous Positive Airway Pressure Ventilation (> PL2)

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Continuous Positive Airway Pressure Ventilation (> PL2) Clinical Indications: 1. Respiratory distress from the following etiologies: Congestive Heart Failure (CHF), Pulmonary Edema, Submersion or Drowning, Chronic Obstructive Pulmonary Disease (COPD), Acute Respiratory Distress Contraindications: 1. Respiratory arrest or Agonal respirations 2. Unconsciousness 3. Hypoperfusion associated with cardiac insufficiency 4. Pneumothorax 5. Facial trauma, including burns Preparation for Use: 1. Ensure all equipment is assembled, and connect CPAP to O2 source and follow PEEP clinical procedure for settings. Precautions: 1. Possible complications include: Gastric distention, Reduced cardiac output, Hypoventilation, Pulmonary barotrauma, Excessive secretions, and the similar Procedure: 1. Ensure oxygen is flowing prior to placing device on the patient’s face. 2. Fully explain the procedure to the patient. 3. Have the patient hold mask to face and instruct the patient to breath slowly and deeply. 4. Once the patient is comfortable with the mask, then securely attach the headpiece and tighten to fit. 5. Continuously monitor the patient’s respiratory status/effort, SpO2, and EtCO2 6. The adjunctive delivery of a medication nebulizer with the CPAP is approved and should be considered. Patient presentation and distress should dictate the timing or use of this procedure. The delivery of nebulized medication should not delay the use of CPAP. 7. If the patient decompensates, then discontinue CPAP and manage the patient per the appropriate clinical guideline. The following are signs of decompensation: a. Decreased level of consciousness b. Decreased SpO2 from initial reading with CPAP application c. Bradycardia with hypotension or signs of hypoperfusion with cardiac insufficiency d. Respiratory arrest, agonal respirations, or ineffective respiratory effort e. Pneumothorax CLINICAL OPERATING GUIDELINES CLINICAL PROCEDURE UPDATED: 02.01.2021 (MD 20-14) PAGE 1 of 1 CONTINUOUS POSITIVE AIRWAY PRESSURE .

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Non-Invasive Ventilation Made Ridiculously Simple
NON-INVASIVE VENTILATION MADE RIDICULOUSLY SIMPLE Jennifer Newitt, MD 3rd year Pulmonary/Critical Care Fellow Mentor: Patrick Strollo Jr, MD Myth or Fact ?!? Myth or Fact ?!? Treatment for Obstructive Sleep Apnea ■ Lifestyle Modifications – Weight loss, increased fitness – Avoid alcohol, sleep deprivation, sedatives – Lateral position, head of bed elevation ■ Surgical – Upper airway reconstruction (UPP) or tracheostomy – Upper airway stimulation ■ Positive Airway Pressure via mask ■ Oral appliance therapy Treatment for Obstructive Sleep Apnea ■ Lifestyle Modifications – Weight loss, increased fitness – Avoid alcohol, sleep deprivation, sedatives – Lateral position, head of bed elevation ■ Surgical – Upper airway reconstruction (UPP) or trach – Upper airway stimulation ■Positive Positive Airway Pressure Airway via mask Pressure via mask ■ Oral appliance therapy 3 decades later…! Continuous Positive Airway Pressure (CPAP) ■ Continuous level of positive pressure provided to overcome airway obstruction ■ Patient must inhale and exhale over continuous pressure ■ Patient initiates all breaths ■ No additional pressure above level of CPAP is provided Continuous Positive Airway Pressure (CPAP) ■ Fixed CPAP – Fixed level of pressure between 4-20 cm H20 (ex: 10 cm H20) ■ Auto-CPAP – Variable pressure according to patient needs as detected by machine – If apnea, hypopnea, flow limitation, or snoring are detected, pressure is increased until events are eliminated – If no events are detected over set time period, pressure is decreased – Set pressure
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Policies & Procedures Title: CPAP/BiPAP-Non Invasive Ventilation (NIV) - Care and Monitoring of the Patient • Post-operative care • Acute respiratory failure Number: 1114 Authorization: Source: Nursing Date Effective: January 2016 [X] SHR Nursing Practice Committee Scope: SHR Acute Urban Any PRINTED version of this document is only accurate up to the date of printing 30-May-16. Saskatoon Health Region (SHR) cannot guarantee the currency or accuracy of any printed policy. Always refer to the Policies and Procedures site for the most current versions of documents in effect. SHR accepts no responsibility for use of this material by any person or organization not associated with SHR. No part of this document may be reproduced in any form for publication without permission of SHR. Overview The following policy applies only to the use of NIV for adult patients with acute respiratory failure (see appendix A, post-operative patients and dyspnea in palliative care patients. It does not apply to the treatment of sleep disordered breathing, chronic, stable respiratory failure or pediatric patients. Definitions: Non-Invasive Ventilation is the provision of ventilatory support through the patient’s upper airway using a mask or similar device. For the purposes of this policy, both continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BiPAP) will be generically referred to as non- invasive ventilation (NIV). Note: See SHR policy 7311-60-024 https://www.saskatoonhealthregion.ca/about/RWPolicies/7311-60- 024.pdf for the application of non-invasive ventilation for acute respiratory failure. Continuous Positive Airway Pressure (CPAP) is a continuous positive airway pressure that is used to provide a patent airway during periods of sleep apnea.
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1. Ventilator Management
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Mechanical Ventilation
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