CPAP and BiPAP

Course overview

Objectives Describe the general use of CPAP and BiPAP and their differences Explain the pathophysiology of how CPAP and BiPAP benefit patients in need Describe case review involving airway physiology terminology review Content 1 Management of Adequate and Inadequate Respiration 1 Respiratory Compromise 1 Assure an adequate airway 2 Review supplemental oxygen therapy 3 Continuous Positive Airway Pressure CPAP Bi Level Positive Airway Pressure BiPAP 1 Definitions Purpose 1 CPAP a device to provide continuous positive airway pressure in the spontaneously breathing patient 2 BiPAP a device to provide differential positive airway pressure in the spontaneously breathing patient 1 higher positive pressure during inspiration eg 10 cm water pressure 2 lower positive pressure during expiration eg 5 cm water pressure 3 augments patients spontaneous breathing with positive pressure ventilation during inspiration 3 increase lung compliance 4 reduce alveolar collapse 5 increase laminar airflow 6 decrease intubation rates 2 Indications 1 CHF Acute pulmonary edema 2 COPD Asthma 3 Near drowning 4 Similar equipment may be used for home treatment of sleep apnea 4 Contraindications 1 inability to tolerate the mask 5 Complications 1 requires adequate tidal volume 2 the patient must be alert and follow instructions 3 the patient must tolerate the mask 4 gastric insufflation 5 vomiting and aspiration risk 6 barotrauma 7 facial hair 8 dysmorphic faces 6 Procedure 7 Assisted positive pressure ventilation 1 Purpose definition 2 Indications 3 Contraindications 4 Complications 5 Procedure 8 Assisting patient ventilations 1 Review of techniques used by EMRs EMTs and AEMTs 1 Purpose 2 Indications 3 Contraindications 4 Complications 5 Procedures 2 Review of the physiologic differences between normal and positive pressure ventilation 3 BiPAP CPAP 1 Purpose 2 Indications 3 Contraindications 4 Complications 5 Procedure Positive End Expiratory Pressure PEEP 1 Purpose 1 expiration 2 refers to positive pressure situations 3 to increase lung compliance 2 Indications provide positive airway pressure to prevent alveolar collapse at the end of expiration 1 hemodynamically stable patient receiving positive pressure ventilation 1 COPD 2 CHF 3 drowning 2 Patient transfer 3 Contraindications 4 Complications 1 can diminish venous return 2 can cause barotrauma 5 Procedure 1 Venous return preload 1 skeletal muscle pump 2 thoracoabdominal pump 3 respiratory cycle 4 gravity 5 effects of IPPB PEEP CPAP and BiPAP on venous return