Transcript CPAP - Central Westmoreland Career and Technology Center

CPAP
Respiratory therapy EMT-B
CPAP Overview
 Applies continuous pressure to airways
to improve oxygenation.
 Bridge device to improve oxygenation
until underlying cause of the respiratory
distress can be treated.
Primary Goal of CPAP
 The primary goal of CPAP is to decrease the work of
breathing so the patient doesn’t deteriorate, doesn’t
require intubation—which is associated with increased
mortality—and doesn’t suffer respiratory arrest.
C-PAP vs. PEEP
 C-PAP non-invasive
 ? PEEP for intubated
patients
 ? Terms used
interchangeably
Control of Breathing
 CO2 Level in
Arterial Blood
 ? Hypoxic Drive
Gas Exchange
 Ventilation-allow oxygen to move from the air into the
venous blood and carbon dioxide to move out.
 Diffusion-Blood carries oxygen, carbon dioxide, and
hydrogen ions between tissues and the lungs. The
majority of CO2 transported in the blood is dissolved in
plasma
 Perfusion-blood flow through the pulmonary arterioles.
Ventilation
Diffusion
Perfusion
Congestive Heart Failure
 The primary cause of respiratory distress with heart
failure is increased work of breathing.
In heart failure, the heart cannot efficiently pump the
blood delivered to it.
Congestive Heart Failure
 The role of CPAP in the treatment of heart failure is
twofold
 1. The PEEP helps keep the alveoli open during
exhalation, and inspiratory pressure helps to open
additional alveoli, relieving the work of breathing;
2. The pressure generated by CPAP helps move fluid
back into the vascular system.
Congestive Heart Failure
 Pulmonary edema
washes out surfactant
 – Increased work of breathing to
maintain open alveoli
COPD
 Chronic Obstructive Pulmonary Disease
 – Emphysema
 – Chronic Bronchitis
 – Asthma
Emphysema
 Loss of elasticity of
lung tissue
 – Difficulty exhaling
 • Air trapping
 • CO2 retention
 ? Break down of
 alveolar walls
 – Decrease surface
area for gas exchange
Chronic Bronchitis
 Chronic
Inflammation of
bronchiole tree with
increased mucous
production
 ? Difficulty exhaling
 – Air trapping
 – CO2 retention
Asthma
 Intermittent
Bronchoconstriction
Difficulty exhaling
 – Air trapping
 – CO2 retention
Physiological Benefits of C-PAP
 Increase in alveolar pressure
 – Stop fluid movement into alveoli
 – Improves gas distribution
 – Prevents alveolar collapse
 – Improves re-expansion of alveoli
 Reduces work of breathing
 Reduces respiratory muscle fatigue
Physiological Benefits of C-PAP
 Increases intrathoracic pressure
 – Improves cardiac output to a point
 – Too much PEEP decreases cardiac output
 Decreases need for intubation and
associated complications
Hazards/Complications of C-PAP
 Airway
 – Mask impairs access to patient’s airway
 – C-PAP does not ventilate the patient
 – Gastric distension / vomiting
 • Aerophagia (swallowing air) sensitive patients
 – Gastric stapling
 – Upper GI surgery
Hazards/Complications of C-PAP
 Hypoxia
 – Loss of oxygen supply
 • Empty oxygen tank
 • Disconnection of Oxy-PEEP from oxygen
source
 – Mask Leak
 – Rebound hypoxia may be more severe
 than initial hypoxia
Hazards/Complications of C-PAP
 Hypotension
 – Increased intrathoracic pressure causes
 • Decreased venous return
 • Decreased cardiac output
 – Increased pulmonary pressure causes
 Decreased blood flow through pulmonary
vessels
 • Decreased cardiac output
Hazards/Complications of C-PAP
 Patient Discomfort
 – Requires patient cooperation to tolerate a
 tightly fitting mask
 • Sensation of smothering or claustrophobia
 – Use trial to introduce patient to device prior
 to securing head strap
 – Consider sedation for extreme anxiety with
 orders from Medical Control
Procedure
 Prepare Patient
 – Position Stretcher at 45 degrees or higher
 – Inform patient of procedure
Procedure
 Mask Application
 – Trial to introduce device
 • Explain patient will feel positive oxygen
 pressure
 – Hold mask gently on patient’s face
 ensuring good seal
 – Once patient accepts mask, secure mask
 with straps
 – Deflate mask as needed to get good seal
Procedure
 On-Going Care / Monitoring
 – Reassess at least every 5 minutes
 • Patient’s impression of difficulty breathing
 • Vital signs
 • Lung sounds
 • SpO2
 – Observe for complications
 • Hypotension
 • Barotrauma
 • Worsening dyspnea
Procedure
 If patient continues to have severe
difficulty breathing after 5 minutes,
consider increasing PEEP to 10 cm
 H2O
 – Systolic BP must be at least 90 mmHg
 – CAREFULLY watch for complications of
increased PEEP
Discontinuing C-PAP
 C-PAP usually is not discontinued in the
field
High PEEP level may require weaning
 Rebound hypoxia can be worse than
initial hypoxia