tag:blogger.com,1999:blog-7423880838207203660.post6403789944662074597..comments2024-01-10T09:56:49.324-05:00Comments on Respiratory Therapy Cave: Myth Buster: What BiPAP settings are bestRick Freahttp://www.blogger.com/profile/01132949384071592216noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-7423880838207203660.post-39547056159768724442013-08-31T12:06:02.722-04:002013-08-31T12:06:02.722-04:00Newer BiPAP machines are more than capable of brea...Newer BiPAP machines are more than capable of breathing for a patient with no rate. Now, whether or not to do this is up to the clinical caregivers. You should never say never in the medical profession, because you can always find a case that meets the exception, such as the end stage COPD patient who is a DNR. Rick Freahttps://www.blogger.com/profile/01132949384071592216noreply@blogger.comtag:blogger.com,1999:blog-7423880838207203660.post-30700391241982949282013-08-31T04:58:32.533-04:002013-08-31T04:58:32.533-04:00My issue is with myth number 2. If the patient ra...My issue is with myth number 2. If the patient rate is 0, are they not apneic? And if that is the case my argument would be that they need the airway secured by more invasive means. Perhaps we operate differently, but here it would be unheard of to BiPAP a patient who has no respiratory drive. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7423880838207203660.post-59018552568140378602013-08-25T10:27:40.449-04:002013-08-25T10:27:40.449-04:00Scott, bipap machines will compensate for leaks, a...Scott, bipap machines will compensate for leaks, as long as they aren't excessive. If you set the pressure at 20 you will get a pressure of about 20 despite any leak you might have, as long as the leak isn't greater than 100L (at which point you will get a "disconnect" alarm).Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7423880838207203660.post-22710410962082163192013-08-20T06:00:19.883-04:002013-08-20T06:00:19.883-04:00True. However, it can be done, although as a shor...True. However, it can be done, although as a short term fix only. I have done it, and usually with a doctor standing over my shoulder saying, "turn it up until the sat is at least 85%." You have to remember that the idea settings are unique to the patient. Note: if the ideal IPAP is equal or greater than 20, notify the physician if he is not already lurking over your back. <br /><br />Rick Freahttps://www.blogger.com/profile/01132949384071592216noreply@blogger.comtag:blogger.com,1999:blog-7423880838207203660.post-52115244415090145142013-08-15T20:39:43.816-04:002013-08-15T20:39:43.816-04:00Rick,
Thank you for the post.
I like myth number...Rick,<br /><br />Thank you for the post.<br /><br />I like myth number 1: <br />You will always get the argument that mask ventilating at pressures > 20-25 cmH2O is the opening pressure of the cardiac/pyloric sphincter and will lead to abdominal inflation, distention, gastric re-flux, vomiting, and aspiration. <br /><br />This argument is based on the passively ventilated patient, with a good mask seal (from anesthesia literature during induction).<br /><br />As you & many RT's have experienced NIV there are many leaks & that you should have a small leak to insure the interface is not too tight (leading to skin breakdown). So you may need higher pressures.<br /><br />Patients requiring NIV are usually in the acute stage of Respiratory distress, so they have vigorous inspiratory drives, so you may need a higher pressure.<br /><br />Additionally, look at home BiPap machines, I have a friend woes machine will auto-titrate pressures up to 30 cmH2O. <br /><br />Basically, as you already stated "assess your patient" and adjust accordingly.<br /> K. Scott Richeyhttps://www.blogger.com/profile/05478522157370156562noreply@blogger.comtag:blogger.com,1999:blog-7423880838207203660.post-9515092335714513552013-08-08T09:17:16.318-04:002013-08-08T09:17:16.318-04:00The human esophageal opening pressure is about 20 ...The human esophageal opening pressure is about 20 cm H2O. It is recommended not to set the IPAP above this to prevent opening of the upper esophageal sphincter, which could result in gastric insuffluxation, gastric distension, emesis, and aspiration. If you do go above this, you might need to suction the stomach with an NG tube or OG tube. This isn't an issue with the ventilator because the ET tube bypasses the esophageal opening and the cuff prevents air from entering the esophagus. If it weren't for this issue, we would rarely need invasive mechanical ventilation.Anonymousnoreply@blogger.com