Page 237 - Clinical Application of Mechanical Ventilation

Noninvasive Positive Pressure Ventilation 203

Used with permission by Philips Healthcare

Figure 7-5 A full-face mask in use.

does not inherit problems with air leaks and pressure sores around the nose and
mouth. The full-face mask is ideal for claustrophobic patients, mouth breathers,
and patients without teeth or with facial abnormalities (Philips, 2012). Figure 7-5
shows a full-face mask.

POTENTIAl PROBlEmS wITh INTERfACES

Since patients are different in size and facial structure, the selection of an interface
must be done on an individual basis. Following selection of an interface, a trial
period usually is required for the patient to get used to the interface and to identify
problems with it.

TITRATION Of CONTINUOUS POSITIVE
AIRwAy PRESSURE

When positive airway pressure is used to treat or relieve OSA, the appropriate CPAP
level is done by setting the CPAP level or by adjusting the inspiratory positive
airway pressure (IPAP) and expiratory positive airway pressure (EPAP) at the same
The initial CPAP is started level, initially at 4 cm H O. After setting up the machine and placing the inter-
at 4 cm H 2 O, and titrated to a 2
desired endpoint. face on the patient, pulse oximetry readings and number of apnea episodes during
polysomnography are used to fine-tune the CPAP level.

Autotitration

Autotitration (autoadjusting) CPAP equipment are available for long-term home
treatment to improve effectiveness by ensuring that the pressure is near optimal
to the patient’s needs. The working mechanism by which these equipment titrate

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