The article was consulted professionally by Master, Dr. Tong Van Hoan – Emergency Resuscitation Doctor – Emergency Resuscitation Department – Share99 Da Nang International Hospital. The doctor has 10 years of experience in the field of Emergency Resuscitation.
BiPAP non-intrusive artificial ventilation is a respiratory support method for patients with heart and lung problems,… This method of artificial notification is indetrained, contraintrained for each specific case.
1. What is BiPAP non-intrusive artificial informed?
Patients who are unable to breathe naturally may adopt artificial ventilation. Artificial 4th throughamatic 400m( non-intrusive) and intrusive 300% Non-intrusive througheration is a method of not using an inemanular tube or opening the inemanation.
BiPAP (bilevel positive airway pressure) is a non-intrusive artificial zer method that partly supports the patient's natural respiration with 2 levels of continuous positive pressure in the air path including:
- IPAP: Positive pressure breathing in, equivalent to PSV;
- EPAP: Exhaled positive pressure, equivalent to PEEP;
The purpose of this method of artificial notification is to:
- Reduces average pressure and peak pressure in the airway, reduces complications of increased pressure and chest tension for patients;
- Reduces the resistance of exhalation flow, reduces the patient's respiratory work, helps oxidize the blood and avoids the risk of collapse of the lungs.
The advantages of this method are improved gas exchange, reduced respiratory work, no need to put in-administration tubes or open the inemandation, help patients be more pleasant, reduce the risk of complications due to in-administration and opening of the inemanation. At the same time, bipap non-intrusive artificial ting is simple, easy to implement, highly effective and low cost, contributing to improving the quality of life for patients.
2. Non-intrusive artificial air retressing/contrain specifying
Respiratory support in cases of respiratory failure but still breathing. Specifically:
- After surgical anesthesia;
- After cardi lung surgery;
- Mild levels of acute chronic obstructive pulmonary disease, acute lung damage, progressive respiratory failure, acute pulmonary edema;
- Heart failure;
- Suffers from sleep apnea syndrome;
- After in-administration tube drainage;
- Premature babies: Have internal membrane pathology, have apnea, bronchopulmonary dysenteritis, mild – medium stool inhalation syndrome, pulmonary edema, pulmonary bleeding, pulmonary fluid retinal retress, bronchial softness, bronchial repression, pulmonary hypertension, ventilator weaning for pediatric patients who have prolonged intrusive ventilators or extremely premature babies.
- Patients with cardiac arrest, apnea;
- Coma below 10 points, unstable blood pressure, unstable arrhythmias, severe upper gastrointestinal bleeding;
- Obstruction of the airways due to foreign objects, sputum;
- Deformity, surgery or injury to the head and face;
- New gastrointestinal or upper respiratory surgery (less than 7 days);
- Patients who do not cooperate with non-intrusive breathing, have a poor cough or have a consciousness disorder, are incapable of protecting the airways, are at risk of vomiting;
- Very severe airway obstruction;
- Exacerbation of chronic obstructive pulmonary disease due to bacterial infections, sputum obstruction.
3. Implementing bipap non-intrusive artificial notification techniques
- Implementer: Doctor and nurse specializing in Emergency Resuscitation;
- Tools and vehicles: BiPAP ventilators, non-intrusive breathing masks, erile plastic ventilator air paths, regular sputum catheters, closed sputum catheters, oxygen systems, pneumatic systems, suction systems, blood air testers, continuous monitors (electrocardiosis) , vascular, blood pressure, SpO2), bed X-ray machine, ambu ball with mask, oxygen breathing apparatus, emergency pleural opening kits, emergency kits stop existing,…
- Patients: Be explained about the purpose, technical implementation process, possible risks and sign the implementation commitment. After that, the patient does the necessary tests: Blood pressure measurement, vascular, breathing, SpO2, weight, height, calculation of body mass index,…;
- Medical records: Keep a complete record of the parameters to monitor and re-examine the results of the tests.
- Check records: re-check the specify, contraintent and commitment to agree to participate in the technique
- Check the patient: life functions, see if the procedure can be carried out.
- Technical implementation
+ Set initial ventilator parameters:
- FiO2 100% then gradually decreases to maintain FiO2 > 92%
- IPAP 8-12 cmH2O
- EPAP 0-5 cmH2O
- Pressure Support (PS) = IPAP-EPAP
- The difference between IPAP and EPAP should remain around 5cmH2O, BiPAP usually starts IPAP/EPAP of 8/3 or 10/5 cmH2O.
+ Set alarm limits
Set alarm limits, the level of which depends on the specific medical condition of each Patient.
+ Conducting for patients with mechanical ventilators
Explain to the patient to understand and cooperate, then face down the nasal mask or mieng-nose for the patient, the hand the person holds the mask so that it fits properly, check the instructions of the patient breathing according to the machine, when the patient breathes on the machine, cooperates well to use a fixed wire
+ Adjustment of ventilator parameters:
If PaO2 falls
- Increase FiO2 every 10% to reach SpO2 > 92%.
- Increase IPAP and EPAP each time by 2cmH2O, which can increase IPAP to 20cmH20 and EPAP to 10-12cmH2O.
If PaO2 increases: Reduce FiO2 every 10% to reach SpO2 > 92%
Case paCO2 increase (pH <7,3): Tăng IPAP và EPAP mỗi lần 2cmH2O, có thể tăng IPAP đến 20cmH20 và EPAP tăng đến 10-12cmH2O.
PaCO2 Case Reduction (pH>7.45): Reduced IPAP and EPAP each time by 2cmH2O.
- Ventilator activity, airway pressures and alarm status;
- Monitoring anti-machine status: See if the patient is cooperating, otherwise cooperation needs guidance and motivation for patients. In case of failure, the patient's blood oxidation does not improve, the insymed ventilator can be intrusive;
- Blood pressure, pulse, electrocardiosis, SpO2, frequent patient consciousness;
- Blood gas test every 12 – 24 hours depending on the condition, emergency when abnormal developments occur;
- X-ray of the lungs every 1 – 2 days, emergency scan when abnormalities occur.
3.4 Some accidents and handling
- Loss of consciousness: If the patient is in a coma, it is necessary to handle in-administration of inhaled ventilators;
- Hypotension: Treated by infusion, using vascular transport if necessary;
- Pressure trauma: Manifestations are patients against ventilators, hypopural spills, spO2 drops, pneumothorax. The treatment in this case is to place emergency pleural conduction;
- Ventilator infections: Prevent by thoroughly adhering to hospital eptic principles. When the patient is infected, antibiotics should be treated early, according to the principle of down the ladder;
- Ulcers or gastrointestinal bleeding due to stress: Prevent this condition by having patients use proton pump inhibitors.
When in order to perform non-intrusive bipap artificial estuation, patients should coordinate well with their doctor to ensure the best treatment effect, avoiding potentially dangerous complications.
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