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    CPAP

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    आशिष दादा
    CPAP delivers continuous positive airway pressure throughout the respiratory cycle to keep the upper airways open and prevent alveolar collapse. It is a form of noninvasive ventilation that uses a nasal or face mask instead of an endotracheal tube. CPAP increases tidal volumes and decreases respiratory rate. It is commonly used to treat obstructive sleep apnea and postoperative atelectasis. Higher levels of PEEP may be needed in conditions like ARDS. CPAP can improve oxygenation and reduce the work of breathing.

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    CPAP

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    आशिष दादा
    72 views13 pages
    CPAP delivers continuous positive airway pressure throughout the respiratory cycle to keep the upper airways open and prevent alveolar collapse. It is a form of noninvasive ventilation that uses a nasal or face mask instead of an endotracheal tube. CPAP increases tidal volumes and decreases respiratory rate. It is commonly used to treat obstructive sleep apnea and postoperative atelectasis. Higher levels of PEEP may be needed in conditions like ARDS. CPAP can improve oxygenation and reduce the work of breathing.

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    CPAP delivers continuous positive airway pressure throughout the respiratory cycle to keep the upper airways open and prevent alveolar collapse. It is a form of noninvasive ventilation that uses a nasal or face mask instead of an endotracheal tube. CPAP increases tidal volumes and decreases respiratory rate. It is commonly used to treat obstructive sleep apnea and postoperative atelectasis. Higher levels of PEEP may be needed in conditions like ARDS. CPAP can improve oxygenation and reduce the work of breathing.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    72 views13 pages

    CPAP

    Uploaded by

    आशिष दादा
    CPAP delivers continuous positive airway pressure throughout the respiratory cycle to keep the upper airways open and prevent alveolar collapse. It is a form of noninvasive ventilation that uses a nasal or face mask instead of an endotracheal tube. CPAP increases tidal volumes and decreases respiratory rate. It is commonly used to treat obstructive sleep apnea and postoperative atelectasis. Higher levels of PEEP may be needed in conditions like ARDS. CPAP can improve oxygenation and reduce the work of breathing.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 13

    CPAP

    Physiological PEEP: positive pressure within the alveoli in the presence of a


    closed glottis

    PEEP becomes the baseline variable during mechanical ventilation. Normally, 5


    cm H2O of PEEP is applied during mechanical ventilation.

    Increase in FRC and prevent derecruitment of alveoli by application of continuous


    positive airway pressure (CPAP).

    To all intents and purposes, PEEP is CPAP, but the term is used for ventilated
    patients only.
    PEEP maintains constant positive pressure in the lungs throughout exhalation
    so that airway pressure does not fall to atmospheric pressure at end-exhalation.
    Thus, it prevents alveoli from collapsing and aims to improve oxygenation.
    CPAP can also be applied when patient is receiving mandatory breaths from
    ventilator. Eg. IMV

    PEEP levels as high as 15 to 20 cmH2O may be necessary with ARDS, severe


    pulmonary edema, and severe bilateral pneumonia when distal airways may be
    edematous and prone to collapse
    CPAP is one of the methods of Noninvasive positive pressure ventilation (NPPV),
    --a form of mechanical ventilation that uses a mask instead of an artificial airway
    --CPAP is spontaneous breathing at an elevated baseline pressure.
    COMPONENTS:
    i. fitted face/ nose mask/ nasal prongs
    ii. hose
    iii. flow generator
    Advantages:
    •Less need for sedation
    •Fewer complications than intubation and use of ventilator
    Disadvantages:
    •Increased expiratory WOB
    CPAP delivers a predetermined level of pressure throughout the entire
    respiratory cycle.
    Flow generator releases a stream of compressed air through the hose to the
    face/ nose mask and keeps the upper airway open under continuous air
    pressure.

    In normal subjects, CPAP increases tidal volume by 25% and lowers


    respiratory rate by over 30%. In intubated patients, CPAP may decrease WOB
    by 50%. (Aldrich et al. ,1994)

    Suggested treatment of choice in obstructive sleep apnea and postoperative


    atelectasis.
    USES
    Adults with neuromuscular diseases and acute and chronic ventilatory failure,
    Infants and children with acute respiratory failure
    Can prevent the flail action of a paralyzed hemidiaphragm, thereby
    improving the efficiency of the remaining innervated respiratory muscle
    Often used as a weaning mode

    If patients fail to improve or stabilize within a reasonable period on NPPV,


    they should be intubated or provided more sophisticated modes of ventilation
    such As IPPV, IMV
    VARIATIONS
    BiPAP: delivers two levels of pressure
    IPAP: high amount of pressure applied when patient inhales
    EPAP: low pressure during exhalation

    It has been suggested that BiPAP improves ventilation and vital signs more
    rapidly than CPAP in patients with acute pulmonary edema. (Mehta et al,
    1997).
    Patients who use CPAP or BiPAP machines may experience headaches, skin
    irritation, and stomach bloating along with nasal congestion and rhinitis.
    • Simplified pressure-time waveform showing continuous positive airway pressure
    (CPAP). Breathing is spontaneous.
    • Inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure
    (EPAP) are present.
    • Pressures remain positive and do not return to a zero baseline.
    CPAP or IPAP with intermittent mandatory breaths (also called intermittent
    mandatory ventilation [IMV] with PEEP or CPAP).
    Spontaneous breaths are taken between mandatory breaths, and the baseline
    is maintained above zero. The mandatory breaths are equidistant and occur
    regardless of the phase of the patient’s spontaneous respiratory cycle.
    Special Considerations:
    Tightly fitting mask may cause local skin damage from pressure effects of mask and
    straps, eye irritation, nasal irritation and dryness, sinus pain, sinus congestion and gastric
    distension,.
    Complications may include barotrauma, hemodynamic instability
    Contraindications
    •cardiac or respiratory arrest;
    •inability to cooperate, protect the airway, or clear secretions;
    •severely impaired consciousness;
    •non-respiratory organ failure;
    •facial surgery; trauma or deformity;
    •high risk for aspiration;
    •anticipated prolonged duration of mechanical ventilation;
    •recent esophageal anastomosis
    References:
    i. J.M Cairo, Pilbeam’s Mechanical Ventilation: Physiological and Clinical
    Applications, 5th Edition, 2012, Elsevier Mosby
    ii. Ellen Hillegass, Essentials of Cardiopulmonary Physical Therapy, 4th Edition,
    2017, Elsevier
    Positive Pressure Ventilation and Cardiovascular System
    (CVS)
    PPV plays an important role in management of patients with cardiogenic pulmonary
    edema, cardiogenic shock or cardiac arrest and those undergoing mechanical
    circulatory support.
    It may also reduce the need for invasive PPV and improve survival.
    The consequences are:
    i. Decreased cardiac output.
    ii. Decreased myocardial oxygen consumption

    Alviar CL et al., 2018

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