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Continuous Positive Airway Pressure Ventilation

Indications: Any patient complaining of shortness of breath for reasons other than pneumothorax AND:

  • Is awake, oriented, and able to cooperate
  • Has the ability to maintain an open airway (GCS greater than 10)
  • Has a respiratory rate greater than 25 breaths per minute
  • Has a systolic blood pressure above 90 mmHg
  • Uses accessory muscles during respirations


Contraindications:

  • Children under 13 years of age
  • Facial deformities or patient to small for mask to seal. (If the mask doesn’t fit, you can’t use CPAP)
  • Agonal respirations or respiratory arrest
  • Pneumothorax
  • Tracheostomy
  • Unconsciousness


Precautions: Exercise extreme caution when administering CPAP if the patient has:

  • Impaired mental status and is not able to fully cooperate with the procedure
  • Failed at past attempts at noninvasive ventilation
  • Active upper GI bleeding or history of recent gastric surgery
  • Complaints of nausea or is vomiting
  • Inadequate respiratory effort
  • Excessive secretions


Procedure:

  1. Explain the procedure to the patient. Place the patient on continuous pulse oximetry and waveform capnography. Ensure adequate oxygen supply to ventilation device (100% when starting and until SpO2 is >96%).
  2. Place the delivery device over the mouth and nose. Secure the mask with provided straps or the other provided devices.
  3. Use 5 cm H2O of PEEP. Check for air leaks. If the distress does not improve and the patient is tolerating CPAP, increase CPAP pressure to 10 cm H2O, if available.
  4. Monitor and document the patient’s respiratory response to the treatment Continue to coach patient to keep mask in place and readjust as needed
  5. If respiratory status deteriorates, remove device and provide BVM ventilation with or without endotracheal intubation.


Removal Procedure:

  • Remove CPAP therapy ONLY when the patient cannot tolerate the mask or experiences continued or worsening respiratory failure.
  • Consider BVM ventilation and/or intubation if removing CPAP therapy from the patient.


Special Notes:

  • Contact BioTel as soon as you know you are going to use CPAP so the receiving hospital can be prepared for patient
  • Upon arrival at the hospital, do not remove CPAP until hospital therapy is ready to be placed on patient.
  • Most patients will improve in 5-10 minutes. If no improvement within this time, consider ventilation with a BVM.
  • Monitor patient for gastric distention.

 

 

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