Page 240 - Clinical Application of Mechanical Ventilation

206 Chapter 7

SUmmaRy

Noninvasive strategies of assisted breathing have been used successfully in providing
sufficient ventilation and oxygenation support to patients with obstructive sleep apnea
(CPAP), acute ventilatory failure, and impending ventilatory failure (bilevel positive
airway pressure). The two advantages of NPPV are (1) an artificial airway is not
necessary and (2) lower risks associated with endotracheal intubation and traditional
mechanical ventilation.
As with other noninvasive procedures applied to a potentially critical condition,
close monitoring of the patient is an absolute requirement. Use of accessory muscles,
changes in vital signs, and signs of respiratory distress or hypoxia are some indica-
tions that the patient’s condition is deteriorating. The patient must be assessed in a
timely manner. If indicated, the patient should be intubated and mechanically venti-
lated if NPPV fails to stabilize or improve the patient’s condition.

Self-Assessment Questions

1. Which of the following is not true in regard to noninvasive positive pressure ventilation (NPPV)?
A. NPPV requires the use of an artificial airway.
B. NPPV can provide positive end-expiratory pressure (PEEP).
C. NPPV may be used to assist patients with obstructive sleep apnea.
D. NPPV may be used to assist patients with acute ventilatory failure.

2. The titration endpoints of IPAP and EPAP during bilevel PAP may include all of the following measure-
ments except:

A. SpO . C. PvO .
2
2
B. PaO . D. P CO .
2
ET
2
3. Continuous positive airway pressure (CPAP) provides positive airway pressure during _______ and it
functions as _______.
A. spontaneous breathing, NPPV
B. spontaneous breathing, PEEP
C. mechanical ventilation, NPPV
D. mechanical ventilation, PEEP

4. When CPAP is in use, the total amount of work of breathing is provided by the:
A. patient. C. patient and ventilator.
B. ventilator. D. pressure level of CPAP.

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